Hyperglycaemia is common among intensive care unit (ICU) patients and is associated with increased mortality. However, whether intensive or liberal glucose control is more beneficial remains controversial. To compare the benefits and risks of intensive versus liberal glucose control in ICU patients. A Meta analysis of randomized controlled trials. Systematic review and meta-analysis of randomized controlled trials (RCTs). We systematically searched PubMed, Cochrane Library, Embase and Web of Science from inception to October 30, 2024. The review was conducted according to PRISMA guidelines. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool. Data were independently screened and extracted by four reviewers. Relative risks (RRs) were pooled using a random effects model, and trial sequential analysis was performed for the primary outcome. Seventy RCTs were included, comprising 36 502 patients, of which 64 RCTs (32 491 patients, 89%) were conducted in adults and 6 RCTs (4011 patients, 11%) in children. The RR of all-cause mortality after intensive and liberal glucose control was 0.99 (95% CI, 0.93-1.05) in adults. Comparable findings were observed for all-cause mortality in children. Intensive glucose control had a statistically significantly higher risk of severe hypoglycaemia in both children (RR 5.70; 95% CI 2.60-12.51) and adults (RR 3.55; 95% CI 2.49-5.07). However, intensive glucose control had a statistically lower risk of infection in both children (RR 0.83; 95% CI 0.70-0.98) and adults (RR 0.78; 95% CI 0.63-0.97). In the subgroup analysis of adults, a lower risk of infection was observed in all surgical groups, but not in the medical group. There was no statistically significant difference in other complications, including sepsis, acute renal injury, new need for dialysis and need for blood transfusion. Intensive and liberal glucose control had similar effects on all-cause mortality in adults and children, though paediatric data are limited and should be interpreted cautiously. Intensive glucose control reduced infection risk, especially in surgical ICUs, but increased the risk of severe hypoglycaemia. These findings suggest that routine intensive glucose control does not improve survival and should be applied cautiously due to increased hypoglycaemia risk, although it may reduce infection risk, particularly in surgical ICU patients.
Global aging leads to increased age-related cognitive decline and neurodegenerative diseases like dementia. Brain-derived neurotrophic factor (BDNF) is crucial for neuronal survival, synaptic plasticity, and cognitive function, but its levels often decline with age. Physical exercise can potentially elevate BDNF levels in older adults. Previous meta-analyses had limitations in comparing diverse exercise types simultaneously and exploring dose-response relationships. To comprehensively compare the relative effects of exercise types on BDNF levels in older adults and explore dose-response relationships using a multilevel Bayesian network meta-analysis. A systematic search of PubMed, Embase, Web of Science, and the Cochrane Library for randomized controlled trials (RCTs) involving exercise interventions in older adults was conducted until April 2025. Data on BDNF levels, exercise type, duration, frequency, and intensity were collected. A multilevel Bayesian network meta-analysis was performed to compare exercise interventions and explore dose-response relationships. Forty-seven RCTs with 1815 participants were included. Aquatic exercise showed the largest point estimate (SMD = 1.00), followed by mind-body exercise (SMD = 0.61) and mixed exercise (SMD = 0.30). However, the AQE estimate was based on sparse evidence and should be interpreted cautiously. Several exercise modalities exceeded a 0.5-SD distribution-based interpretability threshold. Aerobic, combined aerobic and resistance, and resistance exercises also improved BDNF levels, whereas HIIT remained uncertain in the primary analysis, although the active-comparator-exclusion sensitivity analysis yielded a positive estimate that requires confirmation. Dose-response analyses showed non-linear relationships, with effects observed across dosages and after intervention cessation. Advanced age was linked to diminished effects. Several exercise modalities may increase BDNF levels in older adults, but AQE and HIIT should be interpreted as preliminary or hypothesis-generating. Complex dose-response relationships exist, and age and sex may moderate effectiveness. Treatment rankings should be interpreted cautiously in light of evidence certainty.
Non-suicidal self-injury (NSSI) is highly prevalent in adolescence, yet the fast dynamics of large-scale brain networks remain poorly understood. We aimed to characterize resting-state EEG microstate dynamics in a clinically recruited adolescent NSSI sample and to examine state-dependent changes following acute social exclusion. Resting-state EEG was recorded in hospitalized, medicated adolescents with NSSI and in healthy controls (HCs). An NSSI subgroup then completed EEG assessments before and after either Cyberball-induced social exclusion or a non-stress control condition. Microstate parameters and transition probabilities were analyzed. After multiple-comparison correction, the core baseline finding was robustly reduced microstate A duration in the NSSI group relative to HCs. In uncorrected exploratory analyses, additional differences included shorter durations of microstates B and F, higher occurrence of microstate D, and increased F→D transition probability. A multivariate pattern analysis suggested group-related information but must be interpreted cautiously given the modest sample size. Within the NSSI group, the exclusion group showed reduced microstate A expression and increased microstate D expression relative to the non-stress subgroup, with a broader transition shift toward microstate D. Several interaction effects survived correction. In this medicated inpatient sample, resting-state microstate dynamics differed from HCs, most robustly in reduced microstate A duration, and reorganized after social exclusion. Specificity to NSSI remains uncertain given the absence of an MDD-only clinical-control group and healthy Cyberball comparison. These preliminary findings require replication in larger studies including medication-naive MDD-only, MDD+NSSI, and HC groups.
To evaluate 68Ga-pentixafor PET/CT in the surgical management of primary aldosteronism (PA), with emphasis on its relationship with adrenal venous sampling (AVS), KCNJ5 mutation status, tracer uptake, and postoperative outcomes. This retrospective single-center cohort screened 929 consecutive patients with suspected PA from November 2021 to February 2025. The final cohort included 162 patients who underwent unilateral adrenalectomy and 6-month follow-up; 83 also underwent AVS. Patients treated before September 2024 followed an AVS-guided pathway, and those treated thereafter followed a PET/CT-guided pathway. Outcomes were assessed by PASO criteria. Firth logistic regression, overlap weighting, paired PET/CT-versus-AVS analysis, and genotype-stratified analyses were performed. Clinical and biochemical complete success did not differ significantly between the PET-guided and AVS-guided groups. Among patients with both tests, unilateral PET/CT showed high positive predictive value versus AVS (56/57, 98.2%), but 26 of 82 AVS-confirmed unilateral PA cases had negative or bilateral PET findings. All KCNJ5-mutated patients in the PET-status cohort were PET-positive, whereas 22 of 52 KCNJ5-nonmutated patients were PET-negative. KCNJ5 mutation and CT lesion size were independently associated with PET positivity. SUVmax LI was associated with biochemical complete success, including within KCNJ5-nonmutated patients. 68Ga-pentixafor PET/CT provides strong rule-in information when uptake is clearly unilateral. Negative or bilateral PET/CT, especially in small or KCNJ5-nonmutated lesions, should be interpreted cautiously and should not preclude AVS-based evaluation.
Traditional fermented foods represent complex microbial ecosystems shaped by substrate composition, indigenous processing practices, and local environmental conditions. However, the microbiomes of many traditional fermented foods from Northeast India remain poorly characterized. In this study, the bacterial communities associated with thirteen traditional fermented foods from Mizoram, India, representing both plant- and animal-derived fermentations, were characterized using full-length 16S rRNA gene sequencing on the Oxford Nanopore platform. Sequencing generated approximately 1.94 million high-quality reads, enabling high-resolution taxonomic profiling of the fermented food microbiomes. The microbial communities were predominantly composed of Bacillota, Pseudomonadota, and Cyanobacteriota, although their relative abundances varied considerably among fermented food types. Plant-derived fermented foods were enriched with fermentative bacterial genera, including Bacillus, Lactobacillus, Lacticaseibacillus, Pediococcus, and Weissella, whereas animal-derived fermented foods showed a greater abundance of anaerobic taxa, particularly Clostridium. Alpha diversity analyses demonstrated higher microbial richness in plant-derived fermented foods, while beta diversity revealed clear substrate-dependent clustering of microbial communities. Functional prediction indicated that metabolism-related pathways, particularly carbohydrate and amino acid metabolism, predominated across the fermented food microbiomes, and LEfSe analysis identified distinct microbial biomarkers associated with plant- and animal-derived fermentations. Collectively, these findings provide the first comprehensive microbiome characterization of traditional fermented foods from Mizoram and demonstrate that fermentation substrate is a major determinant of microbial community composition and predicted functional potential. Although full-length 16S rRNA gene sequencing improved taxonomic resolution, taxonomic interpretations were made cautiously at the genus level where appropriate because of the inherent limitations of 16S rRNA gene-based classification.
Accelerating urbanization has intensified psychological stress and mental health problems among urban residents. As accessible natural spaces for leisure and recreation, urban parks have received increasing scholarly attention for the potential restorative effects of their soundscapes. Existing studies have mainly focused on the restorative benefits of visual landscapes or examined only the direct relationship between soundscapes and perceived restorativeness. However, the potential psychological pathway through which soundscape cognitive image is associated with perceived restorativeness via emotional pleasure has not been sufficiently clarified. Based on the stimulus-organism-response framework, this study constructed a model linking soundscape cognitive image, emotional pleasure, and perceived restorativeness. Twelve urban parks in Foshan, China, were selected as case study sites. A field questionnaire survey was conducted among recreational visitors, and 300 valid responses were collected. Python 3.10 was used for data processing and descriptive analyses, and AMOS 26.0 was used for structural equation modeling and mediation tests. The results showed that soundscape cognitive image was positively associated with emotional pleasure. Soundscape cognitive image was positively associated with the being away, fascination, and compatibility dimensions of perceived restorativeness, whereas its direct relationship with coherence was not significant. Emotional pleasure was positively associated with being away and compatibility, was not significantly associated with fascination, and showed a significant negative association with coherence. Bootstrap analysis further indicated that emotional pleasure served as a significant indirect pathway between soundscape cognitive image and being away, compatibility, and coherence. The indirect pathway for coherence was negative and the total relationship was not significant, suggesting that this result should be interpreted cautiously. No significant indirect pathway was found for fascination. This study extends the application of the stimulus-organism-response framework to urban park soundscape research by showing how visitors' subjective soundscape cognition is related to perceived restorativeness through emotional pleasure. Because the study used cross-sectional self-report data, the findings should be interpreted as evidence of statistical associations and potential psychological pathways rather than as proof of causal effects. The results provide empirical references for soundscape evaluation and health-oriented urban park planning.
Although air pollution is associated with the onset and exacerbation of allergic rhinitis (AR), epidemiological studies alone cannot reveal the tissue-level immune mechanisms because factors such as the strength of exposure, duration of exposure, presence of co-pollutants and individual susceptibility are all difficult to control. Experiments on animals have provided support for research on the immune response in the nasal mucosa under controlled conditions. A systematic review and meta-analysis were conducted to quantify changes in nasal mucosal immune-inflammatory markers and to assess the strength of mechanistic evidence from various experiments. According to PRISMA, PubMed, Web of Science, Embase and the Cochrane Library were searched from the beginning until December 2025. Eighteen eligible rodent studies were included. As the primary outcomes, type 2 inflammation-related markers were selected because they had been reported frequently and were biologically central to asthma (asthma/AR), such as eosinophils, IL-4, IL-5, IL-13 and OVA-specific IgE. Other markers included ZO-1, NLRP3, IL-1β, IL-17, IL-33, IFN-γ, neutrophils, lymphocytes and total IgE, and were used as secondary or exploratory outcomes. Pooled effects were expressed as standardised mean differences (SMDs) with 95% confidence intervals, and a random-effects model was used. Exposure to air pollutants was associated with an increase in eosinophils, elevated IL-4, IL-5, IL-13, and OVA-specific IgE; thus, a type 2 inflammatory response had been enhanced. A few studies have also indicated that there may be defects in the epithelial barrier and activation of the innate immune system, as shown by reduced ZO-1 and increased IL-1β/NLRP3. The available evidence did not show a consistent effect on IFN-γ expression. Due to considerable heterogeneity and a lack of mechanistic markers for some other reasons, these results should be interpreted cautiously and are not considered definitive causal pathways. Systematic Review Registration: Identifier: CRD420251265574.
Endothelial activation and microvascular dysfunction are implicated in organ injury in critical illness, yet the prognostic value of the Endothelial Activation and Stress Index (EASIX) may vary across heterogeneous intensive care unit (ICU) populations. We assessed whether admission serum chloride, reflecting early physiologic status at ICU entry, modifies associations between EASIX and clinical outcomes. We retrospectively analyzed 1,196 consecutive adult medical ICU admissions. EASIX was calculated at ICU admission and analyzed as log2(EASIX). Primary endpoints were in-hospital mortality and ICU/hospital length of stay (LOS). The secondary/exploratory endpoint was receipt of renal replacement therapy (RRT). We used multivariable regression with prespecified covariates and tested effect modification by chloride, using interaction terms and spline-based modeling. After multivariable adjustment, log2(EASIX) was not independently associated with in-hospital mortality or LOS. For RRT, admission chloride significantly modified the association between log2(EASIX) and RRT. The EASIX-RRT association was most consistent within the normochloremic range and attenuated at chloride extremes; continuous spline interaction models supported non-uniform effects across the chloride spectrum. Among consecutively admitted adult medical ICU patients, EASIX was not independently associated with mortality or LOS after adjustment for illness severity. We observed heterogeneity in the EASIX-RRT association across admission chloride strata; however, this finding should be interpreted cautiously. These findings are hypothesis-generating and warrant external validation.
Children with β-thalassemia major are at risk for neurocognitive impairment due to chronic anemia, iron overload, and possible neurotoxicity from chelation therapy. Despite improved transfusion and chelation protocols, the impact on cognitive function remains unclear. This study evaluated cognitive performance in children with β-thalassemia major and explored selected clinical and biochemical factors associated with cognitive scores. Seventeen patients aged 6-16 years with β-thalassemia major receiving regular transfusions and 17 healthy age- and sex-comparable controls were included. Demographic, anthropometric, and laboratory data (hemoglobin, ferritin, vitamin B12, and vitamin D) were collected. Cognitive performance was evaluated using the Wechsler Intelligence Scale for Children-Revised (WISC-R). Associations between cognitive scores and selected clinical and biochemical variables were evaluated as exploratory analyses, and key associations involving BMI z-score and transfusion duration were additionally adjusted for age. Patients showed significantly lower verbal IQ (81.9 ± 21.9) and full-scale IQ (83.7 ± 21.0) scores compared with controls (109.1 ± 20.1 and 104.6 ± 19.6; p<0.05). All verbal and performance subtests, including picture arrangement and block design, were reduced. In exploratory analyses, age, BMI z-score, and transfusion duration were associated with selected cognitive scores; however, several of these associations were attenuated after adjustment for age. Vitamin D showed positive associations with selected verbal cognitive scores, while ferritin was not significantly associated with cognitive scores in the revised analysis. Children with β-thalassemia major exhibit lower cognitive performance, especially in verbal domains. Associations with clinical and biochemical variables should be interpreted cautiously. Routine cognitive evaluation and metabolic follow-up are recommended for early detection and multidisciplinary care.
Psoriasis is a chronic inflammatory skin disease with substantial impact on quality of life. This study aimed to investigate the relationship between flavonoid intake and the risk of developing psoriasis, and to assess whether genetic predisposition modifies this association. This prospective study included 121 299 UK Biobank participants free of psoriasis at baseline who completed at least two Oxford WebQ dietary recalls. Incident psoriasis was identified using self-reports, primary care data, and hospital records. Intake of total flavonoids and five subclasses (anthocyanins, flavanones, flavan-3-ols, flavonols, and flavones) was estimated. Multivariable Cox proportional hazards models were used to assess associations, adjusting for sociodemographic, lifestyle, dietary, and clinical factors. Polygenic risk scores (PRS) for psoriasis were used for stratified analyses and interaction testing. Over a mean follow-up of 11.4 years, 822 incident psoriasis cases were identified (0.68%). Moderate flavone intake (0.6-1.5 mg d-1; Q2) was associated with a lower risk of psoriasis (HR 0.66; 95% CI 0.52-0.84), particularly among participants with high PRS, with evidence of a nonlinear association. Similar inverse associations were observed for flavone-rich foods. However, no significant interaction between flavone intake and PRS was detected. Given the low intake levels and the co-occurrence of flavones within nutrient-rich foods, this non-linear association should be interpreted cautiously and may reflect broader diet quality rather than flavone-specific effects.
The geographic expansion of ticks in Europe has increased exposure to tick-borne pathogens, particularly Anaplasma phagocytophilum, the causative agent of anaplasmosis in humans and animals. The recently described A. capra has raised interest as an emerging tick-borne agent with potential veterinary and public health relevance. This study aimed primarily to assess the molecular occurrence of A. phagocytophilum in domestic ruminants and secondarily to screen for the presence of A. capra in Slovakia. From 2023 to 2025, 466 blood samples were collected from sheep (n = 183), goats (n = 118), and cattle (n = 165) from farms in Slovakia. Samples were tested by nested PCR targeting the 16S rRNA gene of Anaplasma spp. Subsequently, Anaplasma-positive samples were screened for A. capra using a groEL gene-based assay. All Anaplasma-positive amplicons were confirmed by Sanger sequencing. No Anaplasma DNA was detected in cattle, whereas 15 sheep (8.2%) and 13 goats (11.0%) were PCR-positive for Anaplasma spp. Sequencing and phylogenetic analysis confirmed all positive samples as A. phagocytophilum, with 99.08-100% identity to reference sequences. Comparative analysis of the partial 16S rRNA fragment revealed nine sequence variants among domestic ruminants, including a dominant variant shared by sheep and goats. A. capra DNA was not detected in any screened sample. The detection of A. phagocytophilum DNA in sheep and goats provides baseline molecular evidence of its occurrence in small ruminants in Slovakia. However, because only a partial 16S rRNA fragment was analysed and no tick samples were included, conclusions regarding strain-level diversity, local transmission cycles, and zoonotic relevance should be interpreted cautiously.
The objective of this study is to describe the modified Maingot keel closure technique as a reinforced fascial closure strategy in patients at high risk of postoperative evisceration and to report the short-term clinical outcomes associated with its application. We present a case series of four patients undergoing midline laparotomy who were considered at high risk for postoperative fascial dehiscence according to a Van Ramshorst score greater than 6. The modified Maingot keel closure technique was performed as primary or secondary fascial reinforcement according to the clinical scenario. Four patients (three women and one man) older than 50 years were included. The Van Ramshorst scores ranged from 7 to 9. The mean operative time was approximately three hours. No intraoperative complications, postoperative evisceration, surgical reintervention, or wound-related complications were observed during follow-up. The mean hospital stay was 4.5 days. The modified Maingot keel closure technique was technically feasible and was associated with favorable short-term outcomes in this selected group of high-risk patients. However, due to the limited sample size and absence of a comparison group, these findings should be interpreted cautiously. Prospective comparative studies with larger populations and longer follow-up are required to determine its definitive role in abdominal wall closure strategies.
Patients with diabetes mellitus undergoing coronary artery bypass grafting (CABG) with saphenous vein harvesting are at increased risk of impaired lower extremity perfusion and wound-related complications. Buerger-Allen exercises have been proposed to improve peripheral circulation; however, evidence supporting their effectiveness following CABG remains limited. This study evaluated the effect of Buerger-Allen exercises as an adjunct to phase I cardiac rehabilitation on lower extremity perfusion and wound healing in diabetic patients undergoing CABG. A randomized controlled trial was conducted involving 60 diabetic patients undergoing CABG with saphenous vein harvesting. Participants were randomly allocated to an intervention group receiving standard phase I cardiac rehabilitation plus Buerger-Allen exercises (n = 30) or a control group receiving standard rehabilitation alone (n = 30). The primary outcome was ankle-brachial index (ABI). Secondary outcomes included wound healing disturbances and peripheral ankle swelling. Postoperative ABI was analyzed using two-way repeated-measures ANOVA, whereas categorical outcomes were analyzed using Fisher's exact test or the Chi-squared test. A significant effect of time on ABI was observed (p = 0.004), whereas neither the group effect (p = 0.754) nor the group × time interaction (p = 0.711) was statistically significant. An earlier resolution of mild wound-related pain was observed on postoperative day 3 in the intervention group (p = 0.038); however, no between-group differences were present on postoperative day 5. No intervention-related adverse events were reported. Buerger-Allen exercises were safe and feasible during early postoperative rehabilitation but did not provide additional improvement in lower extremity perfusion beyond standard rehabilitation during the 5-day postoperative period. The isolated improvement in wound-related pain should be interpreted cautiously. Buerger-Allen exercises did not significantly improve the primary outcome of lower extremity perfusion following CABG. Although they appeared safe and were associated with transient improvement in wound-related pain, further adequately powered studies with longer follow-up are required to determine whether clinically meaningful benefits exist. This study was prospectively registered in the Clinical Trial Registry India (CTRI/2023/10/058535).
The study aimed to evaluate the long-term occurrence of noncarious cervical lesions (NCCLs) in adults previously treated with fixed orthodontic appliances, considering tooth type, gingival phenotype, and the quality and stability of orthodontic treatment outcomes. This observational study included 41 adult patients with complete orthodontic records. Data were collected at three time points: T1, before orthodontic treatment; T2, immediately after removal of fixed appliances and placement of retainers; and T3, during a long-term follow-up visit. At T1 and T2, information was obtained from orthodontic records, plaster models, and intraoral photographs. At T3, patients underwent clinical examination and standardized intraoral photographs. The presence and number of NCCLs were assessed from photographs at the three time points. The Peer Assessment Rating (PAR) index was used to evaluate treatment outcomes and stability. Gingival phenotype and lower fixed retainer status were assessed at T3. Friedman's ANOVA was used for comparisons over time, and the Mann-Whitney test was used for comparisons according to retainer status and gingival phenotype, with a significance level of 5%. The mean interval was 2.5 years between T1 and T2 and 6.5 years between T2 and T3. The PAR index decreased significantly from T1 to T2 and remained stable from T2 to T3. The prevalence of patients with NCCLs was 24.4% at T1, 29.3% at T2, and 39.0% at T3. The number of teeth with NCCLs did not differ significantly between T1 and T2 but was higher at T3 than at T1 (p = 0.020). Premolars and molars were the most affected teeth. Patients with a thick gingival phenotype had fewer teeth with NCCLs than those with a thin phenotype at T1 and T2, but this difference was not statistically significant at T3. In this sample of adults previously treated with fixed orthodontic appliances, the frequency of NCCLs was higher at long-term follow-up, while orthodontic treatment outcomes remained stable according to the PAR index. Premolars and molars were the most frequently affected teeth. The findings should be interpreted cautiously because behavioral, biological, and clinical factors related to NCCLs were not assessed longitudinally.
Total Neoadjuvant Therapy (TNT) is increasingly replacing standard chemoradiotherapy (sCRT) for the treatment of locally advanced rectal cancer (LARC). Data on the use of personalized TNT (pTNT) regimens tailored to patient disease characteristics remain scarce. Accordingly, this study aimed to assess long-term outcomes of pTNT in patients with LARC. This was a secondary analysis of a multicentre retrospective cohort study. Patients treated with pTNT between 2019 and 2022 were compared to a historical cohort from the WAIT trial (2012-2014), which included extended chemotherapy during the interval period (xCRT) or sCRT followed by adjuvant chemotherapy. The main outcomes were 4-year disease-free survival (DFS) and overall survival (OS). Forty patients treated with pTNT were matched with 49 patients from the WAIT trial (25 xCRT, 24 sCRT). All WAIT trial patients underwent surgery, whereas 27 (67.5%) pTNT patients underwent surgery and 13 (32.5%) were managed non-operatively. Median follow-up was 48 months. No significant differences were observed in 4-year DFS (pTNT 70% vs. xCRT 68% vs. sCRT 75%, P = 0.764) or OS (pTNT 82.5% vs. xCRT 80% vs. sCRT 83.3%, P = 0.907). Within the pTNT group, patients with an oCR had significantly higher OS compared to those without oCR (95.2% vs. 68.4%, P = 0.021). Our findings suggest that pTNT achieves comparable survival outcomes to xCRT and sCRT in patients with LARC, despite higher rates of non-operative management. These findings should be interpreted cautiously given the exploratory nature of the analysis and limited sample size. Larger studies with longer follow-up are required to validate these early data.
Radiology occupational safety has historically centred on radiation protection. Although radiation safety remains essential, the digital transformation of imaging has expanded the occupational-health profile of the radiology workforce. Diagnostic radiologists now spend prolonged periods at PACS workstations; radiographers and reporting staff work in display-dependent environments; sonographers are exposed to sustained scanning postures and forceful transducer use; and interventional radiology teams face procedural ergonomic stressors related to standing posture, monitor position, table height, and personal protective equipment. This narrative review synthesizes evidence on musculoskeletal strain, digital eye strain, environmental design, circadian disruption, burnout, and emerging effects of artificial intelligence in radiology work environments. The available evidence is largely cross-sectional, survey-based, or extrapolated from broader occupational-health literature, with fewer longitudinal or intervention studies. Accordingly, causal claims should be interpreted cautiously. We propose a broader occupational-safety framework in which radiation protection is preserved while ergonomic, visual, environmental, organizational, and cognitive risks are addressed as complementary priorities. Practical interventions include evidence-informed workstation configuration, diagnostic display standards, sonography-specific ergonomic practices, interventional suite optimization, structured microbreaks, daylight-aware reading-room design, and institutional strategies to reduce excessive workload and burnout. Future research should evaluate whether these interventions improve health outcomes, diagnostic performance, absenteeism, retention, and long-term professional sustainability.
Diet significantly influences the gut microbiota, with variations in macronutrient content (proteins, fats, and carbohydrates) and the presence of non-digestible carbohydrates, such as fiber, playing crucial roles in shaping microbial composition. This study investigated the effects of four commercial prescription diets (low-carbohydrate, weight-loss, high soluble fiber, and renal) on the fecal microbiome of five healthy domestic cats using a 4×4 Latin square design. Fecal samples were analyzed using Illumina sequencing of the bacterial 16S rRNA gene to assess bacterial community structure and diversity. Results showed that cats fed the renal diet (low protein, high carbohydrate, high fat) were associated with higher relative abundances of the phylum Actinobacteria, particularly Bifidobacterium. The low-carbohydrate diet was associated with higher relative abundances of Adlercreutzia, Collinsella, and Slackia. The high-soluble fiber diet was associated with a higher relative proportion of Streptococcaceae. In contrast, the renal diet was associated with lower relative abundances of Blautia and Erysipelotrichaceae. No significant differences were observed in alpha-diversity indices among diets, whereas beta-diversity analysis showed significant differences in microbial community composition among dietary groups. These findings suggest that dietary composition may influence the fecal microbiome in healthy cats. However, given the exploratory design and compositional nature of the sequencing data, these findings should be interpreted cautiously and considered hypothesis-generating.
The use of herbal medical preparation (HMP) is rising among pediatric oncology patients, often to manage treatment-related symptoms. Their effectiveness remains uncertain, and the risk of herb-drug interactions is underestimated. Objectives were to evaluate the benefit-risk balance of commonly used herbal medicines in pediatric oncology and provide evidence-based recommendations. A retrospective review of herbal medicine-related inquiries submitted to the Angers Regional Pharmacovigilance Centre (2016-2019) was conducted. Fourteen medicinal plants were selected on the basis of their use for abdominal pain, appetite loss, nausea/vomiting, sleep, and anxiety. Their suitability for pediatric use, efficacy, toxicity, pharmacological mechanisms, and potential interactions with anticancer and supportive therapies were evaluated. Data were sourced from European Medicines Agency (EMA) monographs, PubMed, Memorial Sloan-Kettering Cancer Center (MSKCC), and pharmacological reference texts. Benefit-risk ratios and recommendation levels were assigned, and recommendations of proper use were summarized for herbal medicines without any objections. Six medicinal plants were deemed to have a favorable benefit-risk profile: leaf of peppermint, lemon balm and sweet fennel for abdominal pain; ginger for nausea and vomiting; lime tree and valerian for anxiety and sleep disorders. However, evidence remains limited, and product quality may vary. Sweet fennel and valerian should be used with caution in the presence of cytochrome P450 3A4 substrate. Some medicinal plants may be cautiously considered in pediatric oncology, but the risks of pharmacokinetic and pharmacodynamic interactions are substantial. This study proposes a shortlist of plants that may be considered and HMPs with potentially good benefit-risk ratios. These findings should not be interpreted as therapeutic recommendations.
Bipolar I disorder (BD-I) is associated with persistent social-cognitive and emotional impairments; however, little is known about affective theory of mind (ToM), empathy, alexithymia and perceived family functioning in the children of mothers with BD-I. In this case-control study, 80 mothers (40 BD-I, 40 healthy controls; HC) and their children (12-18 years; 40 children of BD-I mothers and 40 children of HC mothers) were assessed. Maternal diagnoses and euthymic status were confirmed using DSM-5-based clinical interviews and standardized mood rating scales. Children completed self-report and performance-based measures assessing affective ToM, empathy, alexithymia, psychiatric symptoms and perceived family functioning, while mothers were assessed for affective ToM. Sensitivity analyses adjusted for child symptoms, alongside exploratory moderation and mediation analyses. Mothers with BD-I and their children showed lower affective ToM than HC. In unadjusted analyses, children of mothers with BD-I also showed lower emotional empathy, greater difficulty identifying feelings and poorer perceived family functioning. After adjustment for child symptom burden, affective ToM and emotional empathy remained significant, whereas alexithymia-related differences were attenuated and family-functioning differences persisted only in selected domains. Secondary exploratory analyses indicated that family integrity was related to variation in selected outcomes, while mediation findings were limited. Children of mothers with BD-I appear to show a selective affective-social vulnerability profile, particularly lower affective ToM and reduced emotional empathy; assessment of selected affective-social domains may therefore help guide early preventive support for high-risk youth. Exploratory mediation findings should be interpreted cautiously and require replication in longitudinal, multi-informant studies.
The adoption of cloud-based applications in regulated bioanalysis has progressed cautiously, largely due to uncertainty regarding the interpretation of existing regulatory expectations and the distribution of responsibilities between organizations and service providers. This recommendation paper from the European Bioanalysis Forum (EBF) provides a bioanalytical perspective on cloud implementation, emphasizing the importance of intended use, data criticality, and cross-functional collaboration throughout the data lifecycle. Rather than prescribing technical solutions, it outlines key considerations for third-party risk management, vendor oversight, and the consistent and proportionate application of existing regulatory principles. Cloud adoption does not change fundamental requirements for data integrity, system validation, or compliance, but introduces a more complex distribution of responsibilities that must be clearly understood and actively managed. The paper supports a risk-based, fit-for-purpose approach that enables confident and effective use of cloud technologies in regulated bioanalysis.