Surveillance for influenza A virus infections in vaccinated poultry flocks remains challenging due to animal welfare, logistical and financial constraints, particularly under current EU regulations governing high pathogenicity avian influenza (HPAI) vaccination. In this field study, we evaluated two environmental sampling (ES) methods - bedding boot swabs and drinker wipes - as alternatives to legally mandated individual bird testing, which involved monthly swabbing of 60 healthy birds (active surveillance, AS) and weekly swabbing of dead or sick birds (passive surveillance, PS). A total of 56 turkey flocks from 23 holdings in Lower Saxony, Germany, were monitored throughout the fattening period following single H9N2 vaccination at hatch. Semiquantitative reverse transcription polymerase chain reaction (RT-qPCR) revealed that, despite vaccination, H9N2 virus incursions occurred at least once in 76.8% (43/56) of flocks during the subsequent fattening period. Influenza A virus detection rate on the basis of individual samples was significantly higher by ES (24.1%) than through AS (10.65%; P<0.0001) or PS (15.6%, P=0.001). Overall, ES demonstrated superior performance in identifying 42/43 infected flocks (99.67%) compared with 30/43 (69.97%) by AS and 38/43 (88.37%) by PS. Heatmap and event-time analyses confirmed that ES reliably identified infection events very early and remained positive longer after initial detection. Non-invasive, animal-friendly ES was easy to implement and well accepted by farmers. Costs for ES surveillance were reduced by 73.5% compared to AS and PS. ES was found to be a sensitive, cost-effective and very practical alternative to conventional surveillance in influenza-vaccinated poultry, with direct relevance for future surveillance strategies in HPAI vaccination programmes.
BackgroundAlzheimer's disease is the leading cause of dementia and constitutes a major public health problem. Recent research suggests that certain chronic infections, particularly periodontal infections, may play a role in the development or progression of this disease. Among the bacteria involved in periodontal disease, Porphyromonas gingivalis has attracted particular attention from researchers.ObjectiveIn this way, the aim of this thesis, conducted in the form of a scoping review, was to analyze existing scientific data on the relationship between Porphyromonas gingivalis infection and Alzheimer's disease.MethodsTo achieve this, a literature search was conducted in several scientific databases leading to the selection of fourteen studies that met the inclusion criteria.ResultsSome of the selected studies have shown the presence of Porphyromonas gingivalis or its virulence factors in the brain tissues of patients with Alzheimer's disease. Experimental studies also indicate that this bacterium can promote certain mechanisms involved in neurodegeneration, namely inflammation and accumulation of amyloid-β.ConclusionsSelected studies point to the existence of an association between exposure to periodontal bacteria and an increased risk of developing Alzheimer's disease.
Breast cancer remains the most prevalent malignancy worldwide, with triple-negative breast cancer (TNBC) being particularly aggressive and resistant to standard therapies. Plant-derived compounds have emerged as promising alternatives due to selective cytotoxicity and reduced adverse effects. Portulaca grandiflora (Portulacaceae), ornamental succulent rich in flavonoids, phenolics, carotenoids, and sterols-phytochemicals commonly associated with anticancer activity-was evaluated for its pro-apoptotic and anti-metastatic potential. Three crude extracts, methanolic (PGM), ethanolic (PGE), and n-hexane (PGH), were initially screened for cytotoxicity, after which the two most active extracts, PGM and PGH, were selected for detailed mechanistic analysis. MTT assay was used for antiproliferative screening against MDA-MB-231 TNBC cells and non-tumorigenic MCF-10 A breast epithelial cells. Apoptosis induction was assessed using sub-G1 cell cycle arrest, Annexin V/PI staining, DNA fragmentation, and caspase-3/7 activation assays. NF-κB signaling and associated survival proteins were evaluated through Western blot, luciferase reporter, and DNA-binding assays. Anti-migratory and anti-invasive effects were analyzed using wound healing and transwell invasion assays. PGM showed the lowest IC₅₀ (79.5 µg/mL at 72 h) with minimal toxicity to MCF-10 A cells. Both PGM and PGH triggered sub-G1 accumulation and dose-dependent apoptosis, with PGM eliciting stronger caspase-3/7 activation, DNA fragmentation, and PARP cleavage. Notably, PGM inhibited NF-κB DNA-binding activity by ~ 60% compared to ~ 40% with PGH, reduced IκBα, TAK1, and Akt phosphorylation, and prevented nuclear p65 translocation, accompanied by downregulation of Bcl-2, Bcl-xL, XIAP, survivin, and Cyclin D1. Migration and invasion were significantly suppressed (p < 0.01), confirming anti-metastatic efficacy. Collectively, these findings demonstrate that P. grandiflora extracts-especially PGM-selectively induce apoptosis and impede metastasis in TNBC cells through suppression of NF-κB signaling activity (association-based evidence), supporting its potential as a phytochemical source for targeted breast cancer therapy. Because pathway-causality was not tested using NF-κB rescue or pharmacological inhibition controls, the mechanistic conclusions are presented as supportive associations rather than definitive proof. Future studies should focus on bioassay-guided compound purification, synergistic combination assessment, and in vivo validation for translational advancement.
Air pollution remains a serious environmental and public-health issue in Iran. Despite the Clean Air Act (CAA), enforcement is limited and compliance is weak. This 2025 scoping review outlines major barriers to CAA enforcement and proposes evidence-based policy actions. Multiple databases including Scopus, Web of Science, PubMed, and Google Scholar were searched and Policy documents, institutional reports, and legal texts were identified through Google and official organizational websites. Finally, a thematic analysis was conducted on the data using a four-dimensional conceptual framework. The data were categorized into four main categories of challenges. In the cultural, information and evidence domain, key issues included low policy priority for air pollution, weak public awareness, insufficient transparency, and lack of evidence for policymaking. Governance-related challenges involved institutional fragmentation, limited authority of the Department of Environment (DOE), multiple actors without coordination mechanisms, weak enforcement, and absence of performance metrics. Financial constraints included reliance on public budgets, lack of sustainable revenue sources, project interruptions due to budgetary constraints, and absence of cost-benefit models. Technical and infrastructural issues included lack of a data-governance system, absence of mandatory data and equipment standards, no technological roadmap, and weak industrial technology and monitoring infrastructure. Governance and institutional challenges represented the predominant share of factors hindering the CAA implementation in Iran. Addressing these challenges requires stronger political commitment, governance reform, sustainable financing, integrated data and monitoring systems, enhanced technical infrastructure, and evidence-based policymaking. A comprehensive, intersectoral, and long-term redesign of air-pollution control mechanisms in Iran is essential.
Physical activity (PA) is a recognized determinant of outcomes in chronic diseases, yet its prognostic role in cirrhosis remains incompletely understood. To evaluate the relationship between habitual PA and liver disease severity, sarcopenia, and mortality in cirrhosis, and to develop a clinically applicable risk stratification model. In this prospective cohort study, 116 patients with cirrhosis were assessed for PA using the International PA Questionnaire-Short Form (IPAQ-SF), from which a PA Index (PAI; 0-7 scale) was derived. Clinical, laboratory, nutritional, imaging, and outcome data were obtained from routinely collected hospital electronic medical records and prospectively verified during scheduled follow-up visits. Predictors of 12-month mortality were identified using Cox proportional hazards models, and a risk-tiered classification system incorporating PAI was generated. Lower PAI was significantly associated with higher Child-Pugh scores (ρ = -0.28, p = 0.002), higher INR (p = 0.005), and lower albumin (p = 0.018). Sarcopenia was most prevalent among patients with low PAI (p < 0.001). Independent predictors of mortality included low PAI (HR = 2.12, 95% CI 1.22-3.68, p = 0.008), Child-Pugh class C, older age, hypoalbuminemia, sarcopenia, and sarcopenic obesity. The proposed risk-tiered model effectively discriminated against 1-year survival (low risk: 89.2%; moderate risk: 64.7%; high risk: 42.5%; very high risk: 18.2%; p < 0.001). The IPAQ-SF-derived PAI independently predicts mortality in cirrhosis and, when integrated with established prognostic factors, enhances risk stratification. Incorporating routine PA assessment into cirrhosis management may refine surveillance intensity, optimize transplant prioritization, and guide individualized prehabilitation strategies.
Artificial intelligence (AI) is increasingly utilized in surgical care for decision support, operative planning, intraoperative guidance, and autonomous functions. While these systems can enhance efficiency and clinical performance, they also introduce risks related to technology, human factors, legal issues, and ethics. Current regulatory and legal frameworks are not fully equipped to address the challenges of AI-assisted surgery. This SAGES white paper synthesizes current regulatory, legal, ethical, and clinical considerations relevant to the deployment of AI systems in surgery. We review market safety regulation, data privacy law, informed consent, malpractice and liability principles, and propose a conceptual framework for understanding risk in surgical AI implementation. Risks associated with surgical AI can be understood through a tripartite framework: risks inherent to the AI system, risks introduced by the clinician-user, and risks arising from institutional deployment. These risks may manifest clinically as diagnostic error, treatment error, compromised informed consent, erosion of patient trust, threats to therapeutic autonomy, and privacy violations. Although surgeons remain the ultimate clinical decision-makers, liability may also extend to developers for defective design or failure to warn, and to institutions for negligent implementation or oversight. The safe integration of AI into surgery requires more than technical performance alone. Robust governance, ongoing performance surveillance, incident response pathways, clinician credentialing, and specialty-society engagement are needed to reduce harm and clarify accountability.
Stunting remains a significant public health challenge in Indonesia, impacting children's growth and development. This study aimed to identify child and maternal factors associated with stunting in children aged 0-59. This study employed a cross-sectional secondary data analysis using the Indonesia Family Life Survey-5 (2014). Variables were selected based on the United Nations International Children's Emergency Fund framework and prior evidence. Stunting was assessed using height-for-age z-scores (HAZ), with children classified as stunted if their HAZ was below -2 standard deviations. Descriptive statistics, bivariate analyses, and multivariable logistic regression were performed to explore associations between various factors and stunting, with adjusted odds ratios (aOR) and 95% confidence intervals (CI) calculated. Of the 4,570 children included, 24.1% were classified as stunted. Factors that reduced the likelihood of stunting included older age, with children aged 12-23 months (aOR 0.111, CI 0.056-0.223) and 24-59 months (aOR 0.039, CI 0.021-0.075) at lower risk, likely due to improved dietary diversity and reduced vulnerability to early-life infections as children grow. Risk factors included low birth weight (< 2.5 kg, OR 3.556, CI 2.938-3.648) and incomplete immunization (aOR 1.511, CI 1.088-2.098). Maternal factors also played a role, with underweight mothers having a higher risk of stunting (aOR 2.122, CI 1.565-2.876), while overweight mothers (aOR 0.244, CI 0.105-0.570) and those who received tetanus toxoid injections (aOR 0.724, CI 0.561-0.935) had a lower risk. These findings highlight the critical role of age, birth weight, and vaccination status in the prevention of stunting among Indonesian children. Policies and programs should focus on improving maternal nutrition, ensuring full childhood immunization, and promoting appropriate complementary feeding practices during early infancy to help prevent stunting and improve child growth outcomes.
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As public access to tetrahydrocannabinol (THC) products expands under state legalization, there is concern for increased use in adolescents under 18 years of age and its subsequent effects. Adverse effects of THC use have been documented such as epilepsy, lethargy, somnolence, and respiratory insufficiency. Additional concern has been raised regarding whether potential increases in THC intoxications presented to the emergency department (ED) would demand a simultaneous increase in resource utilization, like lab testing and hospital admission. Previous studies on the relationship between marijuana and pediatric use demonstrated mixed results, with others indicating an increase in co-ingestion rates when pediatric patients use marijuana. To investigate whether the incidence of THC use in pediatrics increased post-recreational marijuana legalization in 2020 (RML) and if the incidence of co-ingestion in these cases differed significantly from the pre-RML data. This was a retrospective cohort study examining positive urine drug screens (UDS) in pediatrics during an emergency department visit at a community hospital during fixed time periods in 2019 and 2020, on either side of Illinois' legalization of recreational marijuana on January 1st, 2020. Pediatric subjects were defined as those younger than 18 years of age and older than four weeks of age at the time of UDS collection with valid, complete, and reported laboratory results. UDS screens analyzed in this study were collected in the ED of a suburban community hospital from pediatric charts housed on the electronic medical record, where there was a clinical indication for UDS collection and regardless of disposition. UDS may have been obtained for either medical or psychiatric concerns, but the reason for the UDS or patient visit was not collected or analyzed. UDS was considered positive if either amphetamines, benzodiazepines, opiates, Phencyclidine (PCP), cocaine, or barbiturates were identified as present in the urine sample and negative if none of these substances were detected in the urine sample. Both negative and positive UDS were assessed using chi-square and odds ratios to investigate these differences and compare across sex. There were 169 patients with a mean age of 14 years included. Mean age in 2019 (14.1 ± 3.2 years) was comparable to mean age in 2020 (14.7 ± 2.0 years) (two-sample t-test: 0.143 > 0.05). Sex demographics were also not significantly different between cohorts, with 53.4% being female in 2019 and 50.6% in 2020 (chi-square: 0.1318; significance: 0.1318 > 0.05). Between the two time periods, we found no significant difference in pediatric presentation to the ED with THC positive testing (2019: 16 positive UDS of 88 collected [18.18%]; 2020: 17 positive UDS of 81 collected [20.99%]; chi square: 0.211; Significance: 0.646 > 0.05; odd ratio between group: 1.195 [CI 95%: 0.558-2.559]) nor correlation with demographic data. We found a nonsignificant positive association between pediatric THC ingestion and co-ingestion of other substances (amphetamines, benzodiazepines, opiates and cocaine) pre-RML and a nonsignificant negative association post-RML (2019: 1.092 [CI 95%: 0.742-1.606]; 2020: 0.913 [CI 95%: 0.627-1.330]). These findings indicate that THC usage among pediatric patients with positive UDS did not increase with state legalization, nor did co-ingestion rates. There was also no difference in rates of positive or negative UDS between patient sex. This must be considered clinically when anticipating potential co-ingestions while interacting with children who may be using street drugs. Additionally, this data suggests that legalization of recreational marijuana does not significantly change the rate of children presenting to the ED with positive drug screens and can be used by hospital administration and state representatives to anticipate healthcare demands following large-scale drug reclassifications. Further investigation is warranted to evaluate these findings in a larger, multi-center study.
Arachnoid cysts (ACs) are the most common brain cysts, comprising 1% of intracranial lesions, with a higher prevalence in children (2.6%) than adults (0.3%-1.7%). Intraorbital ACs are extremely rare, with only a few cases reported to date, especially in children. While most ACs do not exhibit any symptoms, some cases of symptomatic ACs require surgical intervention to prevent brain damage. This article presents a unique case of a large intraorbital AC with preserved visual acuity in a 3-year-old female with a concise literature review of all intraorbital AC cases reported to date. A 3-year-old Syrian female with a history of congenital ptosis presented with unilateral proptosis and eye pain in her left eye. She had normal visual acuity of 20/20 and a normal optic disc upon ophthalmic examination. Subsequent computed tomography (CT) and magnetic resonance imaging (MRI) identified a large Intraorbital AC, which was subsequently managed through surgical intervention, leading to complete improvement of proptosis. Follow-up imaging of the patient indicated no recurrence (refer to Graphical Abstract). This article underscores the importance of considering surgery in cases of large symptomatic intraorbital ACs even if no signs of visual impairment are present, and highlights the need to recognize intraorbital AC as a rare but a potential cause of proptosis, while emphasizing the role of multimodal imaging in ruling out other possible differential diagnoses.
Adolescence is a critical developmental stage marked by physical, psychological, and cognitive growth, increasing autonomy, social exploration, and risk-taking behaviors. However, these natural transitions in displacement settings are overshadowed by heightened vulnerabilities such as gender-based violence. In many displacement settings, recurrent exposure to violence leads to its acceptance as an unavoidable part of daily life. Sometimes, violence is normalized, leading to further exacerbation of the crisis. Our study explored the in-depth experiences and normalization of abuse and existing barriers to reporting within the internally displaced persons settlement in Cross River State, Nigeria. Our qualitative study included adolescents and young people aged 15-24 years residing in the Bakassi Internally Displaced Persons camp within the Bakassi Local Government Area. Participants were selected via purposive sampling. Data were collected through 12 individual interviews and 3 focus group discussions. Data were transcribed verbatim, and thematic analysis was conducted using NVivo 14 to identify key themes. Findings from the study reveal participants' experiences with sexual exploitation, abuse, harassment, and gender-based violence, as well as their perceptions of abuse and how it is normalized. Contextual factors such as self-blame, societal pressure to accept advances from men, and limited accountability contribute to heightened vulnerability within the camps, which result in emotional and psychological impacts. Barriers to reporting and seeking help included fear of repercussions, lack of trust in authorities or services, and stigma associated with victimhood. Our study demonstrates that normalization of abuse, alongside systemic barriers such as fear of repercussions, stigma, and limited trust in authorities, significantly constrains reporting and help-seeking behaviors. Furthermore, our study identifies weak and largely absent accountability mechanisms as a key structural factor enabling continued abuse. To enhance accountability and safeguard vulnerable populations, appropriate legal penalties and enforcement measures should be applied to all forms of abuse. Additionally, future interventions should also address the underlying vulnerabilities that predispose individuals to abuse, ensuring a more comprehensive approach to prevention and protection.
This paper introduces MatriKS, a new computerized tool for the assessment of fluid intelligence based on Raven-like matrices. Based on knowledge structure theory (KST), a mathematical framework initially designed for efficient assessment and personalized learning, MatriKS is the first large-scale application of KST to fluid intelligence assessment. The validation results for MatriKS, suitable for Italian individuals aged 4 to 11 ( N = 568 ), are presented. A multi-method approach incorporating classical test theory (CTT), item response theory (IRT), and KST was employed. Each of the three approaches, with its own assumptions and models, highlights structural properties of the data that are not captured by the other two. Nevertheless, the three approaches provide an acceptable modeling of the data supporting the adequate functioning of MatriKS. The study concludes by exploring the methodological and practical benefits of using KST for constructing tests and estimating individual cognitive profiles.
Body image disturbances (BID) are central to anorexia nervosa (AN), influencing its development, maintenance and relapse. While mirror exposure (ME) has been shown to reduce BID in adults, research in adolescents is limited. This pilot randomized controlled trial examined the feasibility and effects of ME, added to treatment as usual (TAU), in adolescent inpatients with AN. In addition, we explored changes in body-related attentional bias as a potential mechanism of change. Adolescent female inpatients with AN were randomized to receive either 12 ME sessions over 4 weeks (ME group, n = 11) or TAU (n = 13) in a pre-post design. Primary outcomes were global measures of BID and eating disorder (ED) pathology. Attentional bias was assessed using two eye-tracking paradigms. Relative to TAU, ME did not improve BID or ED pathology. Both groups showed reductions in BID over time. Exploratory post-hoc analyses indicated reductions in body control and avoidance behaviors in the ME but not the TAU group. An attentional bias toward self-defined unattractive body parts was present but did not change over time in either group. In this pilot trial, ME did not provide additional benefits over TAU in improving global BID or ED pathology in adolescent inpatients with AN. Improvements in BID may reflect general therapeutic effects of inpatient treatment. Exploratory analyses indicated potential effects on specific body-related behaviors but require cautious interpretation due to limited power. Future research should examine for whom and at what stage body image-focused interventions may be beneficial. Level I, randomized controlled trial. The study is registered on the German Clinical Trial Register (DRKS; registration number: DRKS0019104).
This study aimed to evaluate the clinical utility of LUMINEX technology in detecting plasma inflammatory factor expression levels (IL-1β, TNF-α, and IL-10) in children with severe and non-severe community-acquired pneumonia (CAP), comparing its performance with traditional ELISA methods for disease severity assessment and prognosis prediction. This study enrolled 72 pediatric patients diagnosed with community-acquired pneumonia at our institution between January 2023 and December 2024, comprising 28 severe cases and 44 non-severe cases, along with 80 age-matched healthy controls. Inflammatory marker concentrations [interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α), interleukin-10 (IL-10)] were quantified in plasma and serum samples using LUMINEX multiplex analysis and ELISA techniques. Comparative analyses examined inflammatory mediator expression patterns across disease severity groups and evaluated their diagnostic discrimination capacity, while prognostic assessments investigated the predictive value of plasma inflammatory markers. Comparative analysis revealed significantly elevated concentrations of IL-1β, TNF-α, and IL-10 in both plasma and serum samples from severe cases compared to non-severe patients (P < 0.05), with non-severe patients also showing higher levels than healthy controls (P < 0.05). Both LUMINEX-based plasma analysis and ELISA serum measurements demonstrated comparable diagnostic accuracy for severe pneumonia identification. Prognostic evaluation indicated that patients with unfavorable outcomes exhibited increased plasma inflammatory marker levels relative to those with favorable prognoses (P < 0.05). ROC analysis showed superior predictive performance for TNF-α and IL-10 (higher AUC values) compared to IL-1β in forecasting clinical outcomes. The detection of plasma inflammatory cytokines in children with community-acquired pneumonia by LUMINEX technology is helpful to determine the condition and evaluate the prognosis of children, and it is worth promoting.
AimIn the United States, 82% of American Indian/Alaska Native (AI/AN) women face violence during their lifetimes, compared to 45.1% of women from all other racial groups. We examined the evolution and impact of the Violence Against Women Act (VAWA) on AI/AN women.Design and MethodsA policy analysis of VAWA and its impact on AI/AN women survivors of violence was completed through the lens of the Tribal Critical Race Theory.ResultsThe findings identified that prior to VAWA (2013), there were significant legal gaps regarding the prosecution of non-Native offenders on tribal lands. Following multiple reauthorizations of VAWA, there has been a reported increase in services for AI/AN women, yet challenges persist due to limited data and jurisdictional complexities. While VAWA has made strides in addressing violence against AI/AN women, systemic issues such as historical trauma, racism, and invisibility continue to hinder effective responses. The complexity of jurisdictional frameworks further complicates law enforcement efforts on tribal lands.ConclusionThis policy analysis underscores the need for continued advocacy for comprehensive data collection and more robust legislative measures that prioritize the unique circumstances of AI/AN communities. Additionally, the analysis can inform policymakers, community leaders, and advocacy groups on the necessity of addressing systemic factors that contribute to violence against AI/AN women, such as the jurisdictional complexities on sovereign Native lands. To enhance policy effectiveness, we must take a collaborative approach with tribal communities and ensure that AI/AN voices are integral to the conversation on violence against women.
Rapid advances in stem cell science have generated stem cell-based embryo models (SCBEMs), multicellular structures derived from pluripotent stem cells that recapitulate key features of early human development without originating from fertilization. Although the literature also refers to these entities as "human embryo models" or "embryoids," this article adopts the term SCBEM to reflect their stem cell derivation and to maintain terminological precision. Originally presented as an alternative research platform to embryos, SCBEMs are increasingly exhibiting embryo-like structural and developmental organization. Their trajectory raises a familiar ethical warning about scientific creation outpacing responsibility and exposes significant gaps in legal definitions that rely on origin-based criteria (fertilization, cloning, parthenogenesis) instead of functional characteristics and demonstrated developmental potential. This article develops a South African-centred analysis within a comparative frame, arguing for a bespoke governance framework that is principled, proportionate, and adaptive. It proposes: (i) revised statutory definitions that are tethered to potential and organization; (ii) specialist oversight and a national register; (iii) a culture-limit policy that is aligned with resemblance (and distinct from the fourteen-day rule which applies in relation to embryos); (iv) bright-line prohibitions on any reproductive use or transfer into human or animal hosts; and (v) mechanisms for public trust, transparency, and cross-border harmonization. The aim is to enable socially valuable research while closing loopholes that could erode ethics oversight and public confidence. This article clarifies the legal-ethical problem through the lenses of potentiality and developmental resemblance, maps the comparative governance of SCBEMs with lessons for South Africa, and offers a model framework which includes definitions, oversight architecture, culture-limit policy, prohibitions, and transparency that are designed to be future-ready. A doctrinal analysis of primary law and authoritative guidance was adopted, supplemented by comparative review and governance design principles (proportionality, accountability, transparency). Where formal sources are silent, policy-ready rules were derived from best-practice codes and ethics literature.
A rapid and robust mass spectrometric approach based on ion suppression effects was developed for the identification and authentication of liquid food samples. Wine was used as a model system to evaluate sample discrimination according to vintage, country of origin, producer and name. A defined mixture of 25 chemical marker compounds was added to each sample, followed by dilution and direct analysis using electrospray ionization mass spectrometry (ESI-MS) operated in selected ion monitoring (SIM) mode. Sample-specific matrix effects on the ionization efficiencies of the marker compounds produced characteristic mass spectral response patterns, which were acquired within approximately 1 min per sample. These patterns were compared with reference data derived from a comprehensive wine database. Multivariate statistical analysis was performed using linear discriminant analysis (LDA) combined with complementary distance-based metrics. The approach was validated using five vintages of several premium wines. High authentication scores were obtained for all samples, demonstrating the suitability of the approach for rapid wine authentication and verification of origin. The results indicate that ion suppression-based MS fingerprinting represents a promising tool for fast, minimal-preparation assessment of authenticity in food analysis.
Colposcopy is used to evaluate cervical inflammation and detect precancerous and other cervical lesions; however, access remains limited in many low-resource settings. Identification of cervicovaginal immune biomarkers associated with specific colposcopic findings may provide insight into mucosal immune alterations linked to increased susceptibility to sexually transmitted infections (STIs) and human immunodeficiency virus (HIV), although these associations do not imply diagnostic or predictive utility in a cross-sectional context. In this exploratory cross-sectional study, 203 adolescent girls (14-19 years) and adult women (25-35 years) from KwaZulu-Natal (KZN; n = 105) and the Western Cape (WC; n = 98) underwent colposcopic assessment for cervical ectopy, discharge, injury/inflammation, and leukoplakia. Cervicovaginal cytokines were quantified using multiplex Luminex assays. Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, and bacterial vaginosis (BV) were assessed. Logistic regression models identified correlates of colposcopic findings. Exploratory model performance metrics, including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), were calculated to describe within-dataset model behaviour. Overall, 75% of participants had at least one colposcopic finding. Leukoplakia was more prevalent in KZN (36% of adolescents and 22% of adults), while cervical discharge was most common in WC (36% in both age groups). In univariate analyses, injectable progestin use was associated with any colposcopic finding (OR = 2.10, p = 0.04), implant use was associated with ectopy in KZN (OR = 6.94, p = 0.04), and BV was associated with cervical discharge (OR = 3.37, p = 0.04). In the exploratory multivariable models, selected cervicovaginal cytokines showed finding- and site-specific associations with colposcopic outcomes. In KZN, higher granulocyte colony-stimulating factor (G-CSF) concentrations and parity were associated with cervical ectopy, while BV was associated with cervical discharge. In WC, interleukin-6 (IL-6) and macrophage inflammatory protein (MIP)-1β were associated with cervical ectopy, whereas lower MIP-1α concentrations were associated with leukoplakia. Measures of model performance varied across outcomes and sites, and should be interpreted within the context of the exploratory study design. Cervicovaginal cytokine profiles were differentially associated with specific colposcopic findings in a site-specific manner. These findings are exploratory and hypothesis-generating, highlighting potential biological correlates of cervical changes. Further validation in larger longitudinal cohorts is required to determine whether these cross-sectional associations are reproducible and biologically meaningful.
In the German healthcare system, the legislator has established various concepts of data-based quality assurance. The Federal Joint Committee (G-BA) regulates external quality assurance procedures through the Directive on Data-Based Cross-Institutional Quality Assurance (DeQS-RL) to improve the quality of care and enable transparent, publicly accessible comparisons between providers. The nationwide implementation of clinical cancer registries (CCRs) was intended to strengthen, in particular, oncological quality assurance and reporting. This article compares the quality assurance concepts of the DeQS-RL and CCRs regarding the consistency of data collection, data quality and analysis, the use of quality indicators, the handling of deviant quality results to address deficiencies, and the publication of outcomes. Under the DeQS-RL, data collection, analysis, and the handling of results are standardized nationwide and mandatory for all providers. In case of deviant quality results, targeted improvement measures are initiated with providers to ensure minimum quality standards across all facilities. CCRs operate largely under state regulations and focus primarily on their respective catchment areas. The responsibility for addressing deviant quality results lies with individual facilities. Comparative results are published exclusively by the G-BA. Unlike CCRs, the G-BA uses three data sources (quality assurance documentation, health insurance data, and patient surveys). Due to binding national specifications and data delivery deadlines, DeQS data demonstrate high completeness, comprehensiveness, and timeliness. Since medical providers do not always comply with their legal obligation to report to CCRs in a timely manner, case histories are often incomplete, impairing quality results and the depiction of care processes. CCRs can make important contributions to oncological quality assurance; however, due to their organization under state law, limited binding nature, and lack of authority to enforce quality standards, they do not constitute an independent alternative to DeQS. Nevertheless, there are synergies between the two approaches, which will soon be utilized in an upcoming DeQS procedure of the G-BA.
Accurate and consistent segmentation of lower-limb muscles across different populations (e.g., children, young adults, and older individuals) remains challenging due to substantial anatomical differences. This study evaluated the performance of deep learning models for the automatic segmentation of lower-limb muscles in typically developed children (TDC). We present a novel investigation into their generalization ability across different cohorts (healthy young people (HY) and post-menopausal women (PMW)). Our focus was on the Attention-Feature-Fusion-Unet (AFFU) model, which incorporates a feature fusion module into U-Net. First, manual segmentation of T1-weighted images from TDC cohort was conducted by different operators and a reproducibility analysis was evaluated. Then a comparison study was carried out with UNet, UNet +  + , and Attention UNet. The model AFFU achieved the best Dice Similarity Coefficient 0.86 and Relative Volume Error 0.09 on children cohort. It also significantly reduced the Hausdorff Distance and Average Symmetric Surface Distance by approximately 34% and 20%, respectively, compared to the baseline U-Net (p < 0.01). It can be observed that larger, regularly shaped muscles achieved higher segmentation accuracy, while smaller and irregular muscles posed difficulties. The experiment showed that a single type of cohort model training is not enough to improve the model generalisation ability. The best results in terms of generalisation were achieved with a training set of mixed multi-class cohorts and a complex model using attention mechanisms.