Objectives: Female genital mutilation (FGM) is a significant public health problem. It is estimated around 14,700 women affected by FGM live in Switzerland, primarily among women with a history of migration. Our qualitative research investigated the sexual health of immigrant women living with FGM in Switzerland, describing their own perception of health, reproductive life and sexuality. Methods: We conducted semi-structured, in-depth interviews with a group of eight immigrant women of African origin living in Switzerland with Type III FGM (infibulation). Results: Seven of the women were from Somalia and one from Ivory Coast. All of the Somali women were mothers and married (two separated), and the Ivorian woman was a single mother. The women in our study reported a low level of sexual satisfaction and reproductive health. They affirmed their desire to improve, or at least change, their condition. Although they rarely talk with their husbands about sexual subject matter, they would like to include them more and improve dialogue. Conclusions: Specific socio-sexual management is recommended when caring for immigrant women living with FGM in order to respond to their specific health care needs. Multidisciplinary approaches may be able to offer more comprehensive health care, including facilitated communication to improve dialogue between women and health care professionals, and eventually between women and their husbands in discussing sexual matter.

This study presents a comprehensive comparative analysis of retrofitting techniques aimed at enhancing the seismic resilience of seismically vulnerable historical buildings. Recognizing the dual objectives of structural safety and architectural preservation, this research evaluates and compares several advanced retrofitting methods, including base isolation, strengthening of masonry, steel bracing systems, Fiber-Reinforced Polymer (FRP) wrapping, and damping devices. Each technique is critically assessed based on its effectiveness in mitigating seismic risks, its compatibility with historical architectural features, and its applicability to various building types. Base isolation is highlighted for its ability to decouple buildings from ground motion, thereby significantly reducing seismic forces and protecting architectural integrity. Strengthening of masonry through the use of fiber-reinforced polymers and steel elements enhances the ductility and strength of masonry walls, making them more resilient to seismic forces. Steel bracing systems are shown to provide essential lateral support, particularly in timber-framed structures, improving overall stability and reducing deformation during earthquakes. FRP wrapping is identified as a versatile technique that strengthens structural elements without compromising aesthetic value, making it suitable for reinforcing concrete and masonry components. Damping devices, including viscous dampers and tuned mass dampers, are discussed for their ability to dissipate seismic energy and control structural vibrations, offering a minimally invasive solution that preserves historical aesthetics. The study also addresses several challenges and research gaps associated with these retrofitting techniques, such as ensuring architectural compatibility, assessing long-term material performance, optimizing cost-effectiveness, and navigating complex regulatory frameworks. By advancing knowledge in these areas, the research aims to foster interdisciplinary collaboration and innovation in the development of retrofitting solutions. Ultimately, this study contributes to the ongoing efforts to safeguard historical buildings against seismic hazards. By leveraging cutting-edge technologies and best practices in structural engineering and architectural conservation, stakeholders can develop sustainable, cost-effective, and culturally sensitive retrofitting strategies that protect valuable cultural heritage for future generations.

Introduction: Parkinson’s disease (PD) patients harboring recessive gene variants exhibit a distinct clinical phenotype with an early disease onset and relatively mild symptoms. Data concerning individualized therapy for autosomal recessive PD forms are still scarce. Methods: Demographic and treatment data of a cohort of PD carriers of recessive genes (9 homozygous or compound heterozygous PRKN carriers, 4 Heterozygous PRKN carriers and 3 biallelic PINK1 carriers) were evaluated. Results: The average Levodopa Equivalent daily dose (LEDD) was 806.8±453.5 (range 152-1810) in PRKN carriers and 765±96.6 (range 660-850) in PINK1 carriers. The majority responded to low/moderate doses of Levodopa. The response to Dopamine Agonists (DA) was often favorable both as initial and longitudinal therapy. 8/13 PRKN and 1/3 PINK1 carriers were treated with amantadine successfully, and this also applied to patients who could not tolerate Levodopa or DA. Conclusions: In the era of personalized treatment, the therapeutic approach in recessive PD gene carriers might differ as compared to idiopathic PD. Lower LEDD doses were efficient even in patients with a very long disease duration, while a few patients were doing well without any Levodopa treatment decades after disease initiation. DA or amantadine could be used as a first and main line treatment regimen if well tolerated. Literature data on therapeutic strategies in carriers of pathogenic mutations in recessive PD genes, including device-aided treatments will be further discussed.

This paper introduces the exponential time differencing (ETD) technique as a numerical method to solve efficiently American vulnerable options pricing. We address several challenges, including removing cross-derivative terms through appropriate transformations, treating early-exercise opportunities using the penalty method, and substituting fixed boundary conditions with corresponding one-sided finite differences. The proposed method is shown to be both accurate and efficient through numerical experiments, which also compare the results with existing methods and analyse the numerical stability and convergence rate.

Background: Atherosclerotic plaque (AP) vulnerability can be assessed by coronary artery imaging techniques. Modern lipid-lowering therapy (LLT) has a stabilizing effect on the AP and reduces the likelihood of progression of vascular remodeling. Methods: Databases searched comprised PubMed, and the Web of Science up to April 2023. In total, 8 relevant articles were selected, and all of them are original clinical studies. Results Based on the results of ODISSEY-J-IVUS, there was a decrease in the percentage change in the normalized total volume of AP by 3.1% in the monotherapy group and by 4.8% in the combined LLT group (p = 0.23). According to GLACOV study normalized total atheroma volume decreased by 0.9 mm3 in the placebo group and by 5.8 mm3 in the evolocumab group (95% CI -7.3 -2.5; p<0.001). Plaque regression was observed in 64.3% of patients receiving evolocumab versus 47.3% of those on placebo. The dynamics of the minimum thickness of the fibrous cap varied within 18.0-62.67 microns while on combined LLT and 13.2-33.19 microns on monotherapy (PACMAN-AMI, Gao F). In the HUYGENS study, a lipid arc regression of 57.5° was obtained on combined LLT and by 31.4° with the statin alone. Conclusion: significant progress in the development of cardiovascular imaging has made it possible to expand our understanding of the morphology of AP, the features of coronary vessel remodeling, and the development of acute cardiovascular complications.

Chronic pain is a source of major alterations in quality of life. It represents significant costs for health systems, and reduces the competitiveness of the working population. Vulnerability can drive the incidence of chronic pain, through its influence on modifiable risk factors, and reduced utilization of health care systems. But vulnerability can also be the consequence of a chronic pain: illness can push people into precariousness. We analysed the factors associated with pain intensity among vulnerable persons with a chronic condition, in five European countries (N=1,364). Pain was, among the whole set of variables, the main predictor of sleep problems, fatigue, depression, self-perceived health, physical and mental quality of life. This is in line with other studies showing the major impact of pain on an individual’s health and life. Multivariable analyses, adjusting for the whole set of variables, showed that women had more intense pain, as well as participants with a lower education level. These results confirm the social component in the complex etiology of pain and clearly plaid in favor of integrated care, taking into account individual characteristics and environment.

This article touched upon various issues regarding vulnerability, disparities amongst community settings, and the effect of air pollution on the populace (low-income communities). Furthermore, the paper emphasized environmental ethics approaches like anthropocentric, nature-centric, and deep-ecological approaches. More so, it addresses the importance of handling these disparities, particularly from the geopolitical dimension, and recommends cross-border cooperation and accountability in promoting environmental justice in India.

The research is based on the question: Can teaching/learning methodologies help to achieve the objective of Sumak Kawsay in Ecuador? a STEAM work approach was applied in technical high school students and higher education students (technological), in order to determine the level of impact in terms of project generation, following the entire process, from the generation of ideas to the linking of projects with society, The analysis was carried out in students from 15 to 22 years old in two institutions in the city of Cuenca, using the method of intentional sampling and the systematic review of scientific articles in the Scopus and Google academic databases of the last 3 years, to determine the level of impact of the prototypes pub-lished in indexed journals. The most striking aspect of the results is that of the 260 students surveyed, only 19.6% of students consider that there are STEAM teachers in the classroom, and only 56.92% of students manage to link their work with society, one of the recommended strategies being the publication of scientific articles and participation in congresses disseminating the high impact work done by students in the classroom.

Chronic kidney disease patients treated by hemodialysis present a high cardio-vascular morbidity and mortality. There is an imperative need for novel biomarkers in identifying and to offer possible therapeutically intervention in these patients. We performed a prospective observational cohort study on 77 patients in the period October 2021 – October 2023. We measured serum plasma levels of Interleukin 1-Beta, Galectin 3, human suppression of tumorigenicity factor 2, bone morphogenetic protein 2 and fibroblastic growth factor 23 at the inclusion. We evaluated the correlations of these biomarkers with cardiac function and structure evaluated by echocardiography. Mean age was 61.02 (±11.81) years, 45 (56.2%) males and with a dialysis vintage of 4.95 (2.4-7.8) years. Median ejection fraction was 51 (43-54 %) and more than two thirds of the patients presented valvular calcifications. Overall mortality was 22%. Interleukin 1-Beta correlated positively with ejection fraction and global longitudinal strain and negatively with left atrium diameter and left ventricle tele systolic diameter. Galectin 3 values negatively correlated with aortic valve fibrosis and mitral valve calcifications and human suppression tumorigenity factor 2 negatively correlated with mitral valve calcifications. Some of these novel biomarkers could be used to better asses the cardio-vascular disease in patients on maintenance hemodialysis.

Severe inherited alpha-1 antitrypsin deficiency (AATD) is an autosomal genetic condition linked to chronic obstructive pulmonary disease (COPD). The significance of heterozygous, milder deficiency variants (Pi*M, Pi*S, Pi*Z) is less clear. We studied AATD genotypes in 145 children (up to 72 months old) with assessed wheezing severity using the Pediatric Respiratory Assessment Measure (BCCH PRAM score). A control group of 74 children without airway obstruction was included. AAT concentration and Pi phenotype were determined from dry blood spot samples using nephelometry and real-time PCR; PiS and PiZ alleles were identified by isoelectrofocusing. Among the wheezers, the Pi*S allele incidence was 2.07% (3 cases) and Pi*Z allele was 6.9% (10 cases). The Pi*Z allele frequency was higher in wheezers compared to controls (44.8% vs. 20.27%) and the general Lithuanian population (44.8% vs. 13.6%) and was similar to adult COPD patients in Lithuania: Pi*S 10.3% vs. 15.8% and Pi*Z 44.8% vs. 46.1%. No association was found between AAT genotypes and wheezing severity. Finding that wheezer children exhibit a frequency of Z* and S* alleles like that found in adults with COPD suggests a potential genetic predisposition that links early wheezing in children to the development of COPD in adulthood. Larger cohort studies are needed to confirm this finding.

Background: Acute kidney disease (AKD) is a known risk factor for increased mortality and evolution towards chronic kidney disease (CKD) in adults. The data regarding children are scarce. The purpose of our study is to explore the risk factor for AKD and impact of AKD following an acute kidney injury (AKI) episode in children on mortality and new-onset CKD. Methods: We retrospectively evaluated 736 children with ages between 2 and 18 years old with AKI admitted in a tertiary care hospital from the west Romania over a 9 years period. Results: AKD incidence following AKI was 17%. Patients that developed AKD were older, with higher baseline serum creatinine values, urea, C reactive protein and lower proteins, haemoglobin and sodium. They were more often exposed to sepsis, critical illness and nephrotoxic medications and presented certain susceptibilities like CKD, neoplasia, anemia, heart failure, arterial hypertension, stem cell transplant and female gender. AKI causes that increased the risk of AKD were intrinsic ones. AKD increased the overall mortality by three times. The factors that independently increased the risk of evolution towards CKD were AKD, acute tubular necrosis and higher baseline serum creatinine values. Conclusions: AKD is an independent risk factor for mortality and new-onset CKD in children.

The field of Cooperative Intelligent Transport Systems and more specifically Pedestrians to Vehicles could be characterized as quite challenging, since there is a broad research area to be studied, with direct positive results to society. Pedestrians to Vehicles is a type of Cooperative Intelligent Transport System, within the group of Early Warning Collision/Safety System. In this article, we examine the research and applications carried out so far within the field of Pedestrians to Vehicles Cooperative Transport Systems by leveraging the information coming from Vulnerable Road Users’, smartphones. Moreover, an extensive literature review has been carried out in the fields of Vulnerable Road Users Outdoor Localisation via smartphones and Vulnerable Road Users Next Step/Movement Prediction, which are closely related to Pedestrian to Vehicle applications and research. We identify gaps that exist in these fields that could be improved/extended/enhanced or newly developed, while we address future research objectives and methodologies that could support the improvement/development of those identified gaps.

Previous studies have shown that agricultural works bear a disproportionately higher burden of HIV, which is the highest HIV prevalence ever reported in any working population in South Africa. This study aimed to assess HIV knowledge, attitudes and practices of agricultural workers, as a precarious and vulnerable workforce. A cross-sectional study design was employed. A pre-piloted paper-based questionnaire was administered to a consenting sample of agricultural workers. Descriptive and inferential statistics were performed using stata version 16.1 software, 0.05 level was used as a measure of significance. The majority of agricultural workers had adequate knowledge level (72.1%) regarding HIV/AIDS. Knowledge was significantly associated with having some level of education,) secondary education (AOR: 1.46, 95% CI:1.01-2.12), and post-matric qualification (AOR: 3.07, 95% CI: 1.61-5.83). The attitudes level of workers towards HIV was good (88.1%). Attitude was negatively associated with residing in informal settlements (AOR: 0.64, 95% CI 0.43-0.97). Majority of participants exhibited poor prevention practices regarding HIV (60.9%). Half of participants reported low condom usage (50.9%) and multiple sexual partners (50.6%). The portrayed risky sexual behavior establishes agricultural workers as an HIV high-risk population. Strategizing non-conventional approaches to HIV prevention and behavior change communication targeting agricultural workers is recommended.

Objective: Evaluation of patients with prosthetic valves who developed infective endocarditis by comparing treatment outcomes in both early- and late-onset IE episodes following prosthetic valve replacement surgery. This study sought to conduct a comprehensive assessment of the efficacy of these methodologies. The insights derived from this assessment will be utilized to enhance the quality of care for individuals with infective endocarditis who have received prosthetic valve replacement surgery. Results: During the period of investigation (January 2018 - December 2022), 78 patients diagnosed with infective endocarditis (IE) on prosthetic valve were admitted to the Infectious Diseases Department of the "Dr. Carol Davila" Central Military Emergency University Hospital in Bucharest. In 28 cases (35.8%), the onset of PVE occurred within 12 months of surgery (early onset), whereas in 50 patients (64.2%), the onset occurred more than 12 months after surgery (late onset). The mortality rate was 35.9% (53.6% among the early onset patients and 26% among the late-onset patients). Among patients who received surgical and medical therapy, the mortality rate was 29.6%, whereas among those who underwent only medical therapy, a 39.2% mortality rate was reported. According to the extracted data, antibiotic therapy was successful in 72.6% of patients. In contrast, a combination of surgical and drug-based approaches resulted in a cure in 76.1% of the patients. The most common etiological agent was Staphylococcus aureus (38.5%), followed by Enterococcus faecalis (26.9%), and Streptococcus mitis (10.3%). The mortality rate of patients with S. aureus was 29.2%, indicating the severity of this infectious agent. Conclusions: Prosthetic valve endocarditis (PVE) is a serious condition associated with a high mortality rate both in the short and long term. Regardless of the therapy used, the risk of death remains high. All patients with PVE who survived received effective early treatment, highlighting the need for prophylactic measures.

Introduction: Postpartum hypertension (PPHT) is hypertension that persists or develops directly after pregnancy. PPHT affects 10% of pregnancies and is the most common cause for re-hospitalization after giving birth. In general, PPHT stems from hypertensive disorders of pregnancy (HDP). The aim of the current interim report of the Basel PPHT registry is to describe the cohort, and to determine feasibility and acceptance of a home-based telemonitoring management strategy (HBTMS) in women with PPHT. Methods: Enrollment in the cohort began in June 2020 during the SARS-CoV-2 pandemic at the University Hospital Basel. Women in the maternity ward were screened for preexisting hypertension, HDP, and de novo postpartum hypertension and after consenting, were enrolled. In this pragmatic non-randomized prospective trial, women in the PPHT cohort could choose, between a HBTMS or usual care which consisted of in-hospital appointments at the hypertension clinic. HBTMS was defined as a smartphone application or a programmed spreadsheet to report blood pressure followed by telephone consultations. Standard of care was hospital-based visits as clinically needed after discharge. All participants were assessed three months after delivery with a standardized clinical visit including a 24-hour blood pressure measurement, blood, biomarker, and urine analysis. Results: 311 participants were enrolled from 06/20-08/23. Mean age was 34±5.3 years. Regarding pregnancy-related medical history: 10 % had preexisting hypertension, 27.3 % gestational hypertension, 53% preeclampsia (PE), 0.3% eclampsia, 6% HELLP (Hemolysis, Elevated Liver enzymes and Low Platelets) and 18.3% had de novo PPHT. More than one diagnosis was possible. Family history of cardiovascular disease was seen in 49.5%, 7.5% had a family history of PE. 23.3% were determined as high risk for PE during pregnancy. The most common type of delivery was C-Section (68.5%), mean hospital stay was 6.3 days (±3.9) and IUGR (intrauterine growth restriction) was seen in 21% of the newborns. 99% of participants chose a home-based management strategy. Conclusion: This first description of the Basel PPHT Cohort showed that a HBTMS is well accepted. This is particularly relevant in the direct postpartum period and even more pertinent when the exposure of hospital visits should be avoided when possible.

In this study, by employing the think-aloud model, schema theory and the perceptual cycle model (PCM) from the perspective of vulnerable road traffic participants, the current traffic imperfections of a target section in Wudaokou were analyzed to explore potential improvement measures to enhance safety. Specifically, the present study recruited 30 local volunteers, which were equally divided into a pedestrian group, bicyclist group and E-cyclist group. The research procedure was mainly divided into three steps. By using the think-aloud method, we analyzed and recorded the contents of oral reports of the experimental road section. Then, through translation, segmentation, coding, analysis and other techniques, we sorted and studied the report data and drew a conclusion that was universal in improving the current road traffic conditions. It is hoped that through this study, on the one hand, the applicability of the oral report method, schema theory and perceptual cycle model in road traffic safety can be verified, and, on the other hand, some better improvement measures can be extracted for the road traffic state of the Wudaokou section.

Early childhood may be a stressful period for families with a significant impact on parents’ mental health and the child’s healthy development. The goal of the SKKIPPI cohort study was to assess the occurrence and determinants of psychosocial stress and mental health disorders in parents as well as in their offspring in early childhood in three German regions. Based on random samples from three residents' registration offices, parents with infants up to 12 months of age at the time of sampling, were invited to participate in the study. A screening online questionnaire was newly developed, available in four languages, to assess common psy-chosocial stressors and mental health problems of parents with small children. The study enrolled 4,984 mothers and 962 fathers. The most common potential psychosocial stressors at baseline were professional problems (mothers 22%, fathers 33%), lack of social sup-port (20%, 14%), and severe, negative experiences in childhood (22%, 16%). Obses-sive-compulsive thoughts (21%, 16%), depressive (9%, 9%) and anxiety symptoms (11%, 7%) were the most frequently reported mental health problems by both parents. Regulatory prob-lems of the child were reported by between 1.5% and 5.1% of parents. The SKKIPPI study showed that a substantial proportion of parents are burdened by psychoso-cial problems and suffer from mental health problems in the first years after birth. Early pre-ventive and low-threshold support measures should be available in the health and social care system. The newly developed questionnaire can be used to screen in the relevant populations in order to avoid disturbances in the mother-child attachment.

Pedestrians, bicyclists, scooterists are Vulnerable Road Users (VRU) in traffic accidents. The number of fatalities and injuries in traffic accidents involving vulnerable road users has been steadily increasing in the last two decades in the U.S. even though road vehicles now have perception sensors like camera to detect risk and issue collision warnings or apply emergency braking. Perception sensors like camera are highly affected by lighting and weather conditions. Camera, radar and lidar cannot detect vulnerable road users in partially occluded and occluded situations. This paper proposes the use of Vehicle-to-VRU communication to inform nearby vehicles of VRUs having trajectories with potential collision risk. An Android smartphone app with low energy Bluetooth (BLE) advertising is developed and used for this communication. The same app is also used to collect motion data of VRUs for training. VRU motion data is smoothed using a Kalman filter and an LSTM neural network is used for future motion prediction. This information is used in an algorithm comparing Time-To-collision-Zone (TTZ) for the vehicle and VRU and issue a driver warning with different severity levels. The warning severity level is based on analysis of real data from a smart intersection for close vehicle and VRU interactions. The resulting driver warning system is demonstrated using proof-of-concept experiments. The method can easily be extended to a VRU collision mitigation system.

As the Autonomous Vehicle (AV) industry is rapidly advancing, classification of non-motorized (vulnerable) road users (VRUs) becomes essential to ensure their safety and to smooth operation of road applications. The typical practice of non-motorized road users’ classification usually takes numerous training time and ignores the temporal evolution and behavior of the signal. In this research effort, we attempt to detect VRUs with high accuracy be proposing a novel framework that includes using Deep Transfer Learning, which saves training time and cost, to classify images constructed from Recurrence Quantification Analysis (RQA) that reflect the temporal dynamics and behavior of the signal. Recurrence Plots (RPs) were constructed from low-power smartphone sensors without using GPS data. The resulted RPs were used as inputs for different pre-trained Convolutional Neural Network (CNN) classifiers including constructing 227×227 images to be used for AlexNet and SqueezeNet; and constructing 224×224 images to be used for VGG16 and VGG19. Results show that the classification accuracy of Convolutional Neural Network Transfer Learning (CNN-TL) reaches 98.70%, 98.62%, 98.71%, and 98.71% for AlexNet, SqueezeNet, VGG16, and VGG19, respectively. The results of the proposed framework outperform other results in the literature (to the best of our knowledge) and show that using CNN-TL is promising for VRUs classification. Because of its relative straightforwardness, ability to be generalized and transferred, and potential high accuracy, we anticipate that this framework might be able to solve various problems related to signal classification.

The manuscript wants to investigate the debate on urban resilience and climate change linking theory and practice, describing the possible innovations that concern urban design, urban normative and regional laws developing in different countries. The approach pursued would encourage resilience and flood protection through smart planning and through the architectural and urban project; considering public space as strategic soil where developing the resilient city, using engineering technical climate defence as new space for citizens and communities. Resilience themes are included in all levels of government and in spatial and strategic development policies such as in some project concerning public and private space and in municipal plans; the urban defense structures has to become new pleasant space for the city; these actions will not only contribute to making cities more resilient but will contribute to the creation of a more pleasant and attractive urban environment. The Resilience is the main keyword of some strategic vision of the Netherlands and of Italian laws and the concept is tested in some best practice such as in Rotterdam, in Bordeaux, in London and in the research carried out by "Arquitectos de Cabecera" in Barcelona. Resilience is seen as a new paradigm of smart planning.

Background: The surgical approach to treating calcaneal fractures, specifically Sanders types II, III, and IV, is still a subject of controversy. The decision to opt for open reduction and internal fix-ation (ORIF) or minimally invasive osteosynthesis (MIOS) remains uncertain owing to varying complication rates. This study intends to examine each treatment’s pros and cons in relation to the incidence of complications. Methods: In this retrospective study, we examined 70 patients treated between January 2018 and September 2022: 50 received ORIF, and 20 underwent MIOS. We evaluated functional outcomes with the Maryland Foot Score and the Creighton-Nebraska Health Foundation Assessment Scale (CNHFAS). We also assessed the amount of anatomical restoration using Böhler’s and Gissane’s angles, determined by radiographic checks, and the frequency of postoperative complications. Results: A significant reduction in the risk of reinter-vention was observed in patients with high anesthetic risks, polytraumatized individuals, and those with comorbidities who underwent MIOS. The chi-square test analysis of postoperative complications highlighted no substantial differences between the ORIF and MIOS groups in rela-tion to tendinitis, chronic pain and swelling, algodystrophy, and surgical wound infections (p > 0.20 for all). Conclusion: ORIF is more suitable for patients who have high motor function re-quirements, a long-term activity schedule and can endure potential additional procedures. This preference is because ORIF provides better anatomical restoration and features a lower osteoar-thritis occurrence rate.

Background: Malnutrition commonly affects patients with oral squamous cell carcinoma (OSCC), which contributes to worsening prognosis. Moreover, specific strategies for diagnosing and managing malnutrition in OSCC are lacking. Methods: This retrospective study included 52 consecutive patients with OSCC who underwent surgery at the University Hospital of Palermo (I) from Jan 2020 to May 2023. In-hospital nutritional support was provided by a dedicated team. The patients were compared with a historical control group of 11 patients. The nutritional treatment consisted of standard oral (ON) or artificial nutrition (AN). Traditional measurements, including bioimpedance-derived body composition and volumetric reconstruction of the posterior paraspinal muscles at the C3 level based on magnetic resonance imaging (MRI-C3), were obtained in 16 patients to investigate sarcopenia. Results: The patients were categorized according to TNM stage: groups A (TNM stages I-III) and B (IVa-IVc). The prevalence of group A patients was 59.6% in the case group and 90.9% in the control group (P

To explore the relevant factors that affect the efficacy of consciousness-regaining therapy (CRT)for prolonged disorder of consciousness(pDOC),a retrospective analysis was conducted on the case data of 114 patients with pDOC admitted to department of functional neurosurgery of Tianjin Huanhu Hospital from January 2019 to January 2022. Basic information on the cases,data on pDOC disease assessment, consciousness-regaining therapy methods, and efficacy evaluation were collected. A total of 114 patients were grouped and compared based on the efficacy at the end of treatment. Among them, there were 61 cases in the ineffective group and 53 cases in the effective group. There was no statistically significant difference (P&gt;0.05) between the two groups in terms of gender, age, etiology, acute cerebral herniation, emergency craniotomy surgery, emergency decompressive craniectomy, time from onset to start of consciousness-regaining therapy , and duration of consciousness-regaining therapy(P&gt;0.05). However, there were statistically significant differences (P&lt;0.05) in terms of secondary hydrocephalus, , consciousness-regaining therapy methods, CRS-R grading before treatment, and GOSE score at 6 months after treatment. Binary logistic regression analysis showed that the type of therapy (OR=0.169, 95% CI: 0.057-0.508) was a related factor affecting the efficacy of consciousness-regaining therapy (P&lt;0.05).Compared with non-invasive therapy, personalized awakening therapy using various invasive consciousness-regaining therapy methods can help improve the efficacy of therapy for pDOC.

Coronary heart disease (CHD) has become a prevalent issue in Indonesia, resulting in a majority of fatalities and illnesses. The most recent guidelines in the United States for managing patients with chronic coronary syndrome (CCS) have undergone significant changes, with the recommendation for conducting percutaneous coronary intervention (PCI) strictly limited to patients who continue to experience symptoms despite receiving optimal medical treatment (OMT). However, adopting this approach may lead to increased morbidity and mortality due to the presence of vulnerable plaque. Vulnerable plaque is characterized by minimal obstruction during coronary angiography (40-70%) and may not produce ischemia during physiological studies. Identifying vulnerable plaques can be accomplished through several methods, among which computed tomography coronary angiography (CTCA) is the most cost-effective approach. Recently, experts have employed different techniques, either with stents or drug-coated balloons, to manage vulnerable plaques, showing the methods to be safe and effective. The other challenge faced by patients with CCS is the possibility of achieving complete revascularization (CR) to reduce the likelihood of future major adverse cardiac events (MACE) and mortality. Both approaches, identifying and intervening in the vulnerable plaque, are difficult to perform in developing countries due to the limited budget. Studies have shown that plant-based diets (PBD) can reverse atherosclerotic plaque and stabilize vulnerable plaque, possibly leading to CR. PBD is an affordable and effective approach, but it requires healthcare providers skilled in educating and implementing this dietary approach with their patients. Large-scale randomized controlled trials in PBD, specifically aimed at addressing the vulnerable plaque and achieving CR, are necessary before implementing the PBD intervention.

This study investigated the influence of single nucleotide polymorphisms (SNPs) in genes asso-ciated with the interferon pathway (IFNAR2 rs2236757), antiviral response (OAS1 rs10774671, OAS3 rs10735079), and viral entry (ACE2 rs2074192) on COVID-19 severity and their association with non-alcoholic fatty liver disease (MAFLD). We did not observe a significant association between the investigated SNPs and COVID-19 severity. While the IFNAR2 rs2236757 A allele correlated with higher creatinine levels upon admission and the G allele with lower band neu-trophils upon discharge, these findings require further investigation. The distribution of OAS gene polymorphisms (rs10774671, rs10735079 did not differ between MAFLD and non-MAFLD patients. Our study population's distribution of ACE2 rs2074192 genotypes and alleles differed from the European reference population. Overall, our findings suggest that these specific SNPs may not be major contributors to COVID-19 severity in our patient population, highlighting the potential role of other genetic factors and environmental influences.

This paper aims to explore how climate change affects electricity generation (fossil-fueled power plants, hydroelectric stations, wind systems and photovoltaics) and energy demand in residential buildings in Greece for the period up to 2050. In both cases RCP scenarios results are considered in the appropriate spatial and temporal dimension. Energy supply technologies were examined through statistical regression models and/or mathematical equations correlating climatic parameters with energy productivity. With respect to energy demand, bottom-up models were developed that integrate behavioral and policy aspects. The analysis showed that climate change is expected to mainly affect electricity generation from hydro and thermal power plants, while the impacts on solar and wind energy are significantly lower. The range of impacts on hydro potential and electricity generation depends on the geographical location of the power plants and shows significant uncertainty due to the corresponding uncertainty in climate models estimates regarding precipitation and runoff changes while showing significant geographical variations. With respect to energy demand, climate change is expected to affect energy consumption, but the expected range of effects depends on both the implementation and the characteristics (deep vs. shallow renovation) of measures for upgrading the thermal performance of the building stock and the intensity of climate change.

Populations with healthcare needs often reside in post-conflict settings where basic services needed to maintain good health may be non-existent or hard to access. Therefore, there is a need for better identification and reallocation of resources as part of the post-conflict health rehabilitation effort. This study applies an asset-based approach to explore the more optimal design of health services and to identify the resource constraints for basic health service delivery to the most vulnerable communities in eastern Congo. We implemented the asset mapping in two phases. Firstly, we combined a qualitative survey with community walks to identify the assets already present in the communities. Secondly, we conducted group discussions to map out assets that are the core of Asset-Based Community Development (ABCD) practice. We finally documented all assets in a Community Asset Spreadsheet. Overall, 209 assets were identified as available and potentially valuable resources for the communities in eastern Congo. Among them, 60 were local associations, 24 were land and physical environment, 43 were local institutions, 46 were individuals, 32 to economy and exchange, and only 6 were related to culture, history, and stories. Drawing upon the findings from the qualitative survey, community walks, and group discussions, we conclude that an important number of resources were in place for basic health service delivery. By activating the existing and potential resources, the most vulnerable populations in eastern Congo might have the required resources for basic health service delivery. Our findings support the use of an asset-mapping research method as appropriate to identify existing and potential resources for basic health services in a post-conflict setting.

We reviewed the current status of a Vulnerable seagrass, Halophila beccarii from the coast of India using the published data from 1977-2020. We found that the seagrass, H. beccarii has a pan India distribution on both east and west coast. It is abundant in the intertidal silty-muddy region on the west coast, while on the east coast it is found on sandy habitats, with few exceptions of muddy habitat. H. beccarii was found to be associated with mangroves or smaller seagrass species within a depth limit of 1.7m. Low salinity and high nitrate levels were observed for the H. beccarii meadows of the west coast due to its association with mangroves. The nutrient levels in H. beccarii meadows of India were comparatively lower than other seagrass meadows. Most of the research on H. beccarii has focoused on its morphometrics (41%), reproductive (33%) and distribution (29%) along the coast of India. Reproductive traits such as flowering and fruiting varying according to the seasons of each coast due to the influence of monsoon and its associated temperature, salinity and nutrient influx. H. beccarii has a great potential of various bioactive compounds, which needs further investigation. Habitat disturbance, anthropogenic pollution and coastal development are the major cause of declining H. beccarii ecosystems in India. Significant loss of the seagrass was observed from the west coast of India due to increased coastal development activities. There is a significant need in quantifying H. beccarii population trends, impact of climate and anthropogenic stressors, economic values of ecosystem services and the role of ecological connectivity for better conservation and management of H. beccarii seascapes across India. There is a need for integration of research outcomes in policy framing for preventing the decline and further loss of this vulnerable seagrass ecosystem.

Background: Maternal diabetes mellitus (MDM) is associated with increased risks for adverse neonatal outcomes. However, the impact of MDM on neonatal outcomes in Bisha, a city in Saudi Arabia, is not well-documented. This study aims to investigate the impact of MDM on neonatal outcomes in the Maternity and Children’s Hospital (MCH), Bisha, Saudi Arabia. Methods: A retrospective cohort study was conducted on 181 pregnant women with diabetes and their neonates diagnosed at Maternity and Children’s Hospital (MCH), Bisha, Saudi Arabia, between October 5, 2020, and November 5, 2022. The primary outcome was a composite of adverse neonatal outcomes, including stillbirth, neonatal death, macrosomia, preterm birth, respiratory distress syndrome, hypoglycemia, and congenital anomalies. Logistic regression analyses were used to adjust for potential confounders. Results: The total sample size was 181. The average age of patients was 34 years (SD=6.45). The majority of the patients were diagnosed with GDM, 147 (81.2%), and pre-GDM, 34 (18.8%). Neonates born to mothers with MDM had a higher risk of adverse neonatal outcomes compared to those born to mothers without MDM (adjusted odds ratio [aOR] = 1.46, 95% confidence interval [CI]: 1.25-1.70). The risks of macrosomia (aOR = 1.74, 95% CI: 1.38-2.19), LBW (aOR = 1.32, 95% CI: 1.06-1.66), and RDS (aOR = 1.57, 95% CI: 1.28-1.93) were significantly higher among neonates born to mothers with MDM. Types of DM were statistically significant with some neonatal outcomes: hypoglycemia (p-value = 0.017), macrosomia (p-value = 0.050), and neonatal death (p-value = 0.017). Conclusion: MDM is associated with an increased risk of adverse neonatal outcomes in Bisha. Early identification and management of MDM may improve neonatal outcomes and reduce the burden of neonatal morbidity and mortality in this population.

Background: Nutritional status and oxidative stress have been implicated in the pathogenesis and persistence of long COVID, but data in patients undergoing hemodialysis (HD) are limited. The present study aimed to investigate the association between pre-infection nutritional status, oxidative stress, and one-year long COVID persistence in HD patients. Methods: This prospective observational cohort study enrolled 115 HD patients with confirmed COVID-19. Nutritional status was assessed using the Controlling Nutritional Status (CONUT) score twice: before infection and three months post-infection. Oxidative markers included malondialdehyde (MDAs), ceruloplasmin, transferrin, and sulfhydryl groups. The endpoint was one-year long COVID persistence. Results: Moderate pre-infection CONUT scores were associated with heightened severe undernutrition risk (p &lt; 0.0001), elevated MDAs (p &lt; 0.0001), and reduced ceruloplasmin levels (p = 0.0009) at three months post-COVID-19 compared to light CONUT scores. Pre-infection CONUT score independently predicted post-COVID oxidative damage [OR 2.3 (95%CI 1.2; 4.6), p &lt; 0.0001] and one-year long COVID persistence [HR 4.6 (95%CI 1.4; 9.9), p &lt; 0.0001], even after adjusting for potential confounders. Conclusion: Moderate pre-infection undernutrition in patients undergoing HD associated with increased post-COVID oxidative stress intensity and heightened risk of one-year long COVID persistence.

Extreme heat is a climate, public health, and environmental justice issue. This case study examined public transit exposure and vulnerability to extreme heat by investigating the microenvironment, land cover characteristics, and social vulnerability of heat-vulnerable bus stops in Knoxville, Tennessee. The community’s temperature and Heat Index information, bus stop point data, land cover characteristics data, and the microenvironment of bus stops (i.e., trees and shelters) were processed and mapped with ArcGIS Pro. The pictures of the microenvironment of the bus stop were collected from Google Maps, and the social vulnerability of the area where the bus stops are located was investigated by analyzing the Center for Disease and Prevention's Social Vulnerability Index. Results found that the most heat-vulnerable bus stops were concentrated in West Knoxville, South, North, Northeast, and Northwest Knoxville. In addition, the most heat-vulnerable bus stops were concentrated in commercial complexes and areas a large number of systematically marginalized populations reside.

Cardiovascular diseases (CVD´s) continue as the primary cause of death worldwide. During the past couple of years, and with the surge of the COVID-19 pandemic, deaths linked to CVD´s were -slightly overshadowed by those deaths related to COVID-19, albeit during the highest peaks of the pandemic. The present study derived form understanding the correlation between both diseases, from the standpoint of patients already diagnosed with CVD´s (n = 41883) and what comorbidities had the highest influence on overall patient death (n = 3637). Obesity, hypertension, and diabetes are all linked to worsening the outcome of COVID-19 positive patients, hence they were considered when looking at the overview of all CVD positive patients. Our finding showed that 1697 deaths were related to diabetes (p < 0.001), 987 deaths were related to obesity (p < 0.001), and lastly 2499 deaths were attributed to hypertension (p < 0.001) individually. Using logistic regression modeling, we found diabetes (OR: 1.744, p < 0.001) and hypertension (OR: 2.179, p < 0.001) had a high impact on patient deaths. Hence, having a CVD diagnosis, with hypertension and/or diabetes seems to increase the likely-hood of complication leading to death in COVID-19 positive patients.

Background and Objectives: The purpose of the study was to analyze the relationships between several clinical and biological factors, but also the tumor topography and surgical strategies used in patients with colorectal cancer. Materials and Methods: We designed an analytical, observational, retrospective study that included patients admitted to our emergency surgical department and diagnosed with colorectal cancer. The study group inclusion criteria were: patients admitted during 2020-2022; patients diagnosed with colorectal cancer (including the ileocecal valve); patients who benefited from a surgical procedure, either in emergency or elective. Results: In our study group, consisting of 153 patients, we accounted for 56.9% male patients and 43.1% female patients. The most common clinical manifestations were pain (73.2% of the study group), followed by abdominal distension (69.3% of the study group) and absence of intestinal transit (38.6% of the study group). A number of 69 patients were operated in emergency (45.1%), while 84 patients (54.9%) benefited from elective surgery. The most frequent topography of the tumor was the sigmoid colon, with 19.60% of the patients, followed by the colorectal junction, with 15.68% of the patients and superior rectum and inferior rectum, with 11.11% of the patients in each subcategory. The most frequent type of procedure was right hemicolectomy (21.6% of the study group), followed by rectosigmoid resection (20.9% of the study group). The surgical procedure was finished by performing an anastomosis in 49% of the patients, an ostomy in 43.1% of the patients, while for 7.8% of the patients, a tumoral biopsy was performed. Conclusions: Colorectal cancer remains one of the most frequent cancers in the world, with a heavy burden that involves high mortality, alterations in the quality of life of the patients and their families, and also the financial costs of the medical systems.

Hereditary cancer syndromes caused by germline mutations account for 5-10% of all cancers. The finding of a genetic mutation could have far-reaching consequences for pharmaceutical therapy, personalized prevention strategies, and cascade testing. According to the National Comprehensive Cancer Network’s (NCCN) and the Italian Association of Medical Oncology (AIOM) guidelines, unaffected family members should be tested only if the affected one is unavailable. This article explores whether germline genetic testing may be offered to high-risk families for hereditary cancer even if a living affected relative is missing. A retrospective study was carried out on 103 healthy subjects tested from 2017 to 2023. We enrolled all subjects with at least two first or second-degree relatives affected by breast, ovarian, pancreatic, gastric, prostate, or colorectal cancer. All subjects were tested by Next Generation Sequencing (NGS) multi-gene panel of 27 cancer-associated genes. In the study population, 5 (about 5%) pathogenic/likely pathogenic variants (PVs/LPVs) were found while 40 (42%) had a Variant of Uncertain Significance (VUS). This study highlights the importance of genetic testing for individuals with a strong family history of hereditary malignancies. This approach would allow women who tested positive to receive tailored treatment and prevention strategies based on their personal mutation status.

Background/Objectives: The purpose of this study was to evaluate the relationship between 1-year mortality and health insurance benefit extension policy items in severe pneumonia pa-tients requiring mechanical ventilation using a South Korean nationwide cohort. Methods: A nationwide population-based retrospective study was conducted using the Korean National Health Insurance database. A total of 1,099 patients (542 patients in the health insurance benefit item group and 557 patients in the control group) were included. The primary outcome was 1-year mortality. Results: Among patients with health insurance benefit extension policy items, 203 patients (37.5%) were diagnosed with hemato-oncological disease, who were categorized as group A, and 339 patients (62.5%) were diagnosed with cerebrovascular, cardiovascular, or rare diseases, who were categorized as group B. Group B had lower 1-year mortality (50.7% vs. 62.5%, P

Background: The methods used in low- and middle-income countries (LMICs) household surveys have not changed in four decades; however, LMIC societies have changed substantially and now face unprecedented rates of urbanisation and urbanisation of poverty. This mismatch may result in unintentional exclusion of vulnerable and mobile urban populations. We compare three survey method innovations with standard survey methods in Kathmandu, Dhaka, and Hanoi, and summarize feasibility of our innovative methods in terms of time, cost, skill requirements, and experiences. Methods: We used descriptive statistics and regression techniques to compare respondent characteristics in samples drawn with innovative versus standard survey designs and household definitions, adjusting for sample probability weights and clustering. Feasibility of innovative methods was evaluated using a thematic framework analysis of focus group discussions with survey field staff, and via survey planner budgets. Results: We found that a common household definition excluded single adult (46.9%) and migrant headed households (6.7%), as well as non-married (8.5%), unemployed (10.5%), disabled (9.3%), and studying adults (14.3%). Further, standard two-stage sampling resulted in fewer single adult and non-family households than an innovative area-microcensus design; however, two-stage sampling resulted in more tent and shack dwellers. Our survey innovations provided good value for money and field staff experiences were neutral or positive. Staff recommended streamlining field tools and pairing technical and survey content experts during fieldwork. Conclusions: This evidence of exclusion of vulnerable and mobile urban populations in LMIC household surveys is deeply concerning, and underscores the need to modernize survey methods and practices.

This research assesses the effectiveness of the Socio-Technical Assistance (STA) program combined with Owner-Driven Housing Reconstruction for rural private housing recovery after Nepal’s 2015 earthquake, particularly targeting vulnerable households. Through a quantitative 304-questionnaire survey, the study reveals that 96% of households credited STA activities for accelerating reconstruction, with 95% acknowledging its significance and 78% emphasizing its necessity. Notably,89% expressed dependency on STA for reconstruction, and 85% believed it heightened disaster risk reduction awareness. In conclusion, the study establishes that STA activities significantly contributed to the successful reconstruction of vulnerable households, addressing critical aspects such as financial support, technical assistance, housing accessibility, earthquake-resilient construction, improved livelihoods, and safety enhancements. The field study presents crucial recommendations to enhance the effectiveness of Socio-Technical Assistance (STA) activities in post-earthquake rural private housing reconstruction. Emphasizing the need for tailored, demand-driven interventions, the study cautions against relying solely on an Owner-driven Reconstruction model, challenging the one-size-fits-all strategy. The study proposes integrating tailored interventions into overarching recovery strategies, advocating for coordinated efforts to enhance Disaster Risk Reduction (DRR) awareness and cultivate resilient communities in particularly vulnerable households. Aligned with United Nations Sustainable Development Goal 11, which focuses on sustainable cities and communities. This research aims to enhance the literature on post-disaster humanitarian shelter and settlement by emphasizing the significance of inclusive and comprehensive approaches to recovery and reconstruction.

Women's attitudes towards domestic violence play an important role in shaping the social acceptance of domestic violence, acting as both a known predictor of victimization and an indicator of disclosure and help-seeking behavior. Therefore, the study objectives were 1) to conduct a nationwide analysis to explore the factors associated with the acceptance of domestic violence among Iraqi women according to the social-ecological framework, and 2) to identify the most vulnerable women according to the spatial distribution of Iraqi governorates. This cross-sectional study was conducted using secondary data analysis from the 2018 Iraq Multiple Indicator Cluster Survey (MICS 6), which included 19,443 married Iraqi women. Logistic regression was employed to examine the factors associated with acceptance of domestic violence. In this study, the analyses were performed according to the Social Ecological Model (SEM). This study revealed that 48.4% of married Iraqi women accepted domestic violence. Yet, women living in South/Central regions of Iraq showed a higher prevalence of domestic violence acceptance namely Anbar, Salahaddin Thiqar, and Misan where the prevalence was (62%-73%). Several factors across the social-ecological model were associated with a higher likelihood of women accepting such behavior, including experiencing functional difficulty, having lower educational attainment, being married to a blood-related husband, and being married to a husband who has multiple wives/partners, living in poverty, residing in rural areas, living in the south and central regions of Iraq, and feeling unsafe in the neighborhood. Conversely, factors that were associated with a lower likelihood of women accepting such behavior were owning a mobile phone and using a computer or tablet. This study provides policymakers with valuable insights to comprehensively assess indicators of attitudes toward domestic violence against women. It also addresses the scarcity of information on the acceptance of domestic violence in Iraq on national and governorate levels, emphasizing the need for urgent national-level policy discussions to achieve key Sustainable Development Goals related to gender equity and good health and well-being.

Climate information can help vulnerable populations anticipate disasters before they happen and enable communities prepare for and cope with them. A complementary log-log regression model based on quantitative study in coastal communities in Tanzania was used to assess the likelihood of the rural poor, rural non poor, urban poor, and urban non poor to receive early warning information about flood, drought and other disasters. Individuals in the urban poor category were 35% less likely to receive early warning information about flood, drought and other disasters whereas urban non-poor residents were 49% more likely to receive same. This disadvantage to the urban poor persists even when adaptive capacity, geographical location and socio-environmental factors are accounted. Nuclear households consisting of a male head and female partner who have children or not had higher likelihood of receiving early warning information on flood, drought and other disasters (OR = 1.47, p < 0.001) compared with their counterparts in female-centred households (no husband or male partner). Residents with tertiary education were more likely (OR = 1.91, p < 0.001) to report that they had received early warning information about flood, drought and other disasters compared with their counterparts without any formal education. This zero-order relationship was completed mediated by geographical location and socio-environmental factors in the multivariate model. The results underline the key role access to climate- and disaster-related information play in enhancing adaptive capacity to reduce vulnerability to natural hazards, as well as the importance of targeting the most vulnerable households in policy interventions to improve resilience in the face of a changing climate.

This paper explores the role of open-source large language models in IoT cybersecurity world. The threats of malicious activity on the Internet and the loss of private information are very real and lead to serious consequences. The purpose of this paper is to investigate how open source-large language models can help to defend against the growing threat of cyber-crimes. We conducted our experiments in two directions. The first one is a security assistant that helps with cybersecurity best practices advices. The second one is a how large language model can simulate a vulnerable IoT system. For both types of experiments, the interactive mode of operation of the language model is used. In the context of the cybersecurity research, a major advantage of the locally installed open-sourced large language models is that they do not share sensitive data with a remote system in a cloud. The paper concludes by discussing the potential impact of open-source large language models on cybersecurity research and recommends future research directions.

COVID-19 Pandemic management has become the top priority of Government Institutions globally, which is justifiable seeing the high mortality of the disease. In India, Lockdowns by National, State and Local level administrations have greatly reduced the spread of the SARS COV-2 Virus. Some areas with a greater proportion of COVID-19 patients have been declared hotspots with increased restrictions on public activities through law enforcement. But quite often delay in identification of these hotspots leads to community transmission of the Virus thus aggravating the problem. A method to identify the areas which are at risk of becoming the next hotspot for the disease is the need of the hour[1]. In this Research document we will find the probable risk factors and make an appropriate scale to measure the vulnerability of an area, identified by its Postal code. To help with this a Pan India survey by the title of “Survey on General Indian population on the level of preparedness for COVID-19 pandemic” was launched and received around 1250 submissions, with the acquired data we will evaluate the risk factors and make appropriate scale to identify ‘pre-hotspots’.

Ulleung County, one of the most medically vulnerable areas in South Korea, requires public attention because of the high incidence of liver cancer. This study was conducted as a part of the Ulleung Liver Cancer Prevention and Management Project. The purpose of this study was to estimate the community prevalence of hepatitis B and C viruses and to identify the associated risk factors. The Project’s interagency workgroup established a procedure for conducting blood sampling and health behavior surveys at the Ulleung Public Community Health Center. A total of 1,792 residents aged 40 years and older voluntarily participated in the study between 2019 and 2022. The hepatitis B surface antigen (HBs Ag) and hepatitis C virus antibody (anti-HCV) positive rates in Ulleung were 7.19% and 1.37%, respectively. Low education level and lifetime smoking were associated with HBsAg positivity, whereas cupping therapy at non-medical institutions was associated with anti-HCV positivity. The odds of HBs Ag positivity were lower among those with tattoos than among those without. There was a difference in the risk factors associated with hepatitis B and C viral infection. While a high HBs Ag positivity rate alone may not fully explain the high incidence of liver cancer in Ulleung, it may be a contributing factor.

In cold-climate regions, road salt is used as a de-icer for winter road maintenance. The applied road salt melts ice and snow on roads, being washed off through storm sewer systems into nearby urban streams, harming the freshwater ecosystem. Addressing the gap in the knowledge regarding the use of deep learning approaches for urban stream water quality forecasting, the present work discusses our implementation of a “Graph Neural Network” - “Sample and Aggregate” (GNN-SAGE) model for forecasting chloride concentrations in the Credit River in Ontario, Canada. The proposed GNN-SAGE is compared to other models, including a Deep Neural Network based transformer (DNN-Transformer) and a benchmarking persistence model for 6 hours forecasting horizon. Ac-cording to the results, the GNN-SAGE model surpasses other models in providing accurate predic-tions of chloride concentrations within the assessed prediction window. Also, a SHAP analysis provides insight into the variables that influence the model’s forecasting, showing the impact of the spatiotemporal neighbouring data from the network and the seasonality variables on the model’s result. The GNN-SAGE model shows potential for use in real-time forecasting of water quality in urban streams, aiding in the development of regulatory policies to protect the vulnerable freshwater ecosystems in urban areas.

Flood is identified as one of the major disasters in the world; it destroys both human and properties across the world, where lives are lost, properties, public infrastructure, farmlands and agricultural produce with farm crops carted away as a result of flood disaster. Studies revealed that the flood in itself is not the danger, but the level of human vulnerability to flooding disaster risk, which enhances its destructive capabilities. However, based on the challenges poses by flood disaster risk, this research identifies Ala river in Akure as a potential cause of flood, considering its location and other human activities around the river. Therefore, the research used Ala-river a case study to identify and mapped out areas susceptible to flood disaster risk. The research made use of both literature review and conducted goe-data gathering with the application GIS-computer database to retrieve georeferencing relevant data from the fieldwork in the study area of Ala-river basin to mapped out locations vulnerable to achieve the research aim. The research adopted a Geo-mapping of the vulnerable area to Ala-River basin using arc-GIS tool in combination with other software such as IKONAS and OLI (Operation Land Imager) for the production of the study area imagery, ER-ITERIM was used for the collection of rainfall data and FAO was applied for digital soil mapping. These applications produced; the land use/land cover map, digital elevation map, buffer map using 30 meters setback, annual rainfall map, soil types map, vulnerability map and soil textural table for the study area. Analysis of the produced and generated maps shows 316 buildings vulnerability to flood disaster risk; the soil texture and types, and alternative use to which the soil types can be useful. The research recommends that demolition of the identified 316 buildings prone to flood disaster and compliance of building construction to 30 meters setback by developers. Others are the conversion of the future land setback for urban agricultural purposes and preservation of water retention areas for agricultural activities during the dry season among others. The study concludes that relevant government agencies in the State and in particular in Akure South Local Government should ensure prompt compliance and implementation of the recommendations to avoid potential flood disaster risks.

(1) Background: Double-strand breaks (DSBs) in a single nucleus are usually measured using the sperm chromatin structure assay (SCSA), sperm chromatin dispersion (SCD) test, and comet assay (CA). We developed mono-dimensional single-cell pulsed-field gel electrophoresis (1D-SCPFGE) and angle-modulated two-dimensional single-cell pulsed-field gel electrophoresis (2D-SCPFGE) to observe DNA fragmentation in separated motile sperm. (2) Methods: We set up comparative standards, calibration curves, the required sensitivity, and eligibility criteria for test sperm to validate their measurement principles. (3) Results: We revealed that the conventional methods overlooked the interference of nucleoproteins in their measurements. In-gel proteolysis improves the measurement accuracies of 1D- and 2D-SCPFGE. We recommend using naked DNA for comparative standards and test specimens. Moreover, we have observed several dysfunctions that may induce DNA damage in the separated motile sperm. Overall, our discussion highlights the need to revisit the conventional univariable analyses based on the SCSA, SCD test, and CA. (4) Conclusions: Human infertility is a complex syndrome, and the aim of quality control in intracytoplasmic sperm injection is to identify the underlying dysfunctions remaining in the separated motile sperm that render them ineligible for injection. Well-designed, multivariable analyses with special consideration to confounding factors are necessary in future cohort studies.

This paper outlines the ongoing development of a specialised mobile application to address the mental health needs of vulnerable populations in the European Union (EU). Conducted as a mixed-methods research within two EU Science and Technology Cooperation Actions, the study prioritises stakeholder feedback to identify features for initial testing and strategies to improve application uptake, using critical digital health analysis. With a focus on marginalised groups such as refugees, migrants and socio-economically disadvantaged individuals, the application aims to provide an accessible and culturally sensitive platform for mental health support, integrating evidence-based interventions such as cognitive behavioural techniques and mindfulness exercises. Key features include multilingual support, habit tracking, personalised recommendations for support and services, and real-time crisis intervention. Collaboration with stakeholders and ongoing rigorous usability testing are driving the refinement process to ensure usability, acceptability and effectiveness, underscoring the importance of user engagement in technology-based mental health interventions in the EU context and highlighting the importance of collaborative science and technology for societal benefit.

The contextual and risk perception of climate change plays a critical role in an individual’s decision-making process. It could also help people to respond appropriately to the consequences of global climate change and eventually take necessary adaptation actions. However, the perceptions of climate change are often gendered and vary among men and women. Therefore, this study explores different perceptions of climate change and its local adaptation options among ultra-poor vulnerable women, particularly in highly vulnerable flood-prone regions of Bangladesh. The research followed an empirical research methodology to collect primary and secondary information using qualitative and quantitative research tools. The study findings reveal that climate change perceptions at the individual level are relatively low (63%). Still, they have been observing significant changes in various climatic variables over the past 30 years. Moreover, this study identified some major adaptation options such as plinth raising (100%), livestock rearing (100%), homestead gardening (82%), seasonal migration (82%), and using indigenous knowledge (69%), and so on to tackle the adverse impacts of climate change-induced extreme events including flooding at the local level. For implementing these adaptation measures, the respondents spent a significant amount of financial resources from individual sources in the study area. Structural Equation Modeling (SEM) is used in addition to the statistical analyses to understand any connections between the climate change perceptions and other variables associated with the community under study. The SEM result shows that climate change will be a long–term problem, which offers a strong predictor in this model, considering standardized regression weight β= 0.56. It means, despite inadequate knowledge on climate change of the respondent’s, climate change is occurring and becoming the worst factor limiting cultural, economic, and environmental development in the study area.

Background: Infantile tibia vara (ITV) is a rare proximal tibia deformity in infancy, leading to progressive knee varus. High tibial osteotomy is commonly practiced but has high recurrence rates. This study analyzed factors affecting treatment failure and recurrence in children undergoing opening-wedge high tibial osteotomy (OWHTO) for ITV. Methods: We retrospectively studied children with ITV who had OWHTO with press-fit cancellous bone allograft between 2000 and 2020, with ≥2-year follow-up. Outcomes included recurrence (knee varus with tibiofemoral angle >10°), complications, and reintervention. Results: We analyzed 39 knees in 29 patients (mean age: 4.8 ± 1.9 years; median follow-up: 7.4 years). Recurrence occurred in 22 cases (56%). Age at surgery significantly influenced recurrence, with rates of 16% before age 5 versus 95% later (hazard ratio: 12.0, p = 0.001). Langenskiöld stage also affected recurrence (β-coefficient: 2.7, 95% C.I. 1.0–4.5, p = 0.002; pseudo-R-squared: 0.50, p = 0.001), with recurrence in all stage III IV or higher cases. Conclusions: Early diagnosis and treatment before age 45, ideally with Langenskiöld stage III or lower, are crucial for stable correction with OWHTO alone. Late, high-grade ITV may require combined, acute or gradual, and/or staged correction. Further evidence is needed for optimal management.

Background: Few studies have investigated the longitudinal association between cervical spondylosis (CS) and migraine by using a nationwide population-based database. Methods: We conducted a retrospective cohort study from 2000 to 2011 identifying 27,930 cases of cervical spondylosis and 111,720 control subjects (those without cervical spondylosis) from a single database. The subjects were frequency-matched on the basis of sex, age, and diagnosis date. The non- cervical spondylosis cohort was four times the size of the cervical spondylosis cohort. To quantify the effects of cervical spondylosis on the risk of migraine, univariate and multivariate Cox proportional hazard regression analyses were used to calculate the hazard ratio (HR) and 95% confidence interval (CI). Results: After a 10-year follow-up controlling for potential confounding factors, overall migraine incidence was higher in the cervical spondylosis cohort than in the non- cervical spondylosis cohort (5.16 and 2.09 per 1,000 people per year, respectively; crude hazard ratio = 2.48, 95% confidence interval = 2.28–2.69) with an adjusted hazard ratio of 2.03 (95% confidence interval = 1.86–2.22) after accounting for sex, age, comorbidities, and medication. Individuals with myelopathy in the cervical spondylosis cohort had a 2.19 times (95% confidence interval = 1.80–2.66) higher incidence of migraine compared than did those in the non- cervical spondylosis cohort. Conclusion: Individuals with cervical spondylosis exhibited a higher risk of migraine than those without cervical spondylosis. The migraine incidence rate was even higher among individuals with cervical spondylotic myelopathy.

The concept of transformative resilience emerges from complex recent literature and represents a way to interpret the potential opportunities to change in vulnerable territories, where a socio-economic change is required. This article extends the perspective of transformative resilience to assessing of the landscape multi-functionality of inland areas, exploring the potentials to identify a network of synergies among the different municipalities able to trigger a process of territorial resilience. A Spatial Decision Support System (SDSS) for multi-functionality landscape assessment aims to support the local actors to understand local resources and multi-functional values of the Partenio Regional Park (PRP) and surrounding municipalities, in the South of Italy, stimulating their cooperation to the management of environmental and cultural sites and the co-design of new strategies of enhancement.

Abstract: Few studies have been conducted in Iraq regarding the association of violence at multiple ecological levels and child mental health outcomes. Therefore, the study objectives were 1) to conduct a nationwide analysis to explore violence at multiple socio-ecological levels and children's mental health outcomes, and 2) to identify the most vulnerable children according to the spatial distribution of Iraqi governorates. This cross-sectional study used the 2018 Iraq Multiple Indicator Cluster Survey (MICS 6), which included 12,358 caregivers who provided complete information regarding their parenting and disciplinary practices regarding their children between the ages of 5 and 14. Logistic regression was employed to examine the factors associated with children’s depression and anxiety. This study showed that 22% of children had depression, while 38% experienced anxiety. Notably, children residing in Iraq's South/Central regions, specifically in areas like Nainawa, Najaf, and Basrah, exhibited notably higher anxiety and depression. The research also showed that living in unsafe neighborhoods, women's acceptance of domestic violence, and the use of severe physical punishment as corporal discipline all contributed to the development of anxiety and depression. This study addresses the scarcity of information on children's mental health outcomes in Iraq at national and governorate levels, emphasizing the need for urgent national-level policy discussions to achieve key Sustainable Development Goals related to ending all forms of violence against children by 2030.

The basis of this project is a health literacy cohort study (LISA) being developed in the county of Leiria. The study aims to reach and monitor the adult population of the county over time. Counting with a multidisciplinary team, the study stakeholders asked the designers to develop the study’s brand so it could be more advertisable to the population, turning the communication between the stakeholders and the public easier. The development of the brand identity and elements of communication used some graphic design approaches. These approaches were reinforced by the opinions given by the interviewed sample of the population, that answered some of the study’s questions. The interviews held by designers allowed the team to receive information about what was expected the study to be, and how and where to better communicate the LISA’s Study. Trough the aforementioned process resulted in the current finalized outcomes of the study’s brand and communication materials. Both printable and digital communication elements (i.e., roll-up, id cards, flyers, QR Code, and website) were developed and disseminated according to the brand's strategy. Concluding, the communication elements created are seen as the first phase of this project, leaving a second phase related to the design and structuration of the Study to be developed, and published in future articles.

Background: While it is established that intravenous catheter placement duration is strongly linked to the risk of catheter colonization and bloodstream infections, there are still substantial knowledge gaps concerning the varying durations of PICC placement that lead to either infection or colonization by common pathogens, particularly MDR pathogens. The present study aims to compare the dwell time required for MDR pathogens to colonize with the time required to cause Central Line-Associated Bloodstream Infections (CLABSIs) in critically ill patients with PICCs and compares it with non-MDR pathogens, shedding light on the significance of preventive procedures to control MDR infections in clinical settings. Methods: Data from critically ill patients with PICCs admitted consecutively to «Metropolitan» Hospital in Athens, Greece, from May 2017 to May 2020 were retrospectively analysed. Results: In this study, 86 hospitalized patients, consisting of 56 (65.1%) males and 30 (34.9%) females, with a mean age of 55.67±21.1 years (range 16-91 years), presented with both CLABSIs and colonization following PICC placements. Specifically, 42 (48.8%) of them presented with CLABSIs, while 44 (51.2%) presented with colonization. Among the total participants, an MDR pathogen was isolated from 26 (30.2%) PICCs, while other pathogens were isolated from 60 (69.8%). The mean duration of catheter dwell time for all participants was 20.94±14.22 days (range 3-72 days). When analysed separately for each group, the dwell time for PICCs with CLABSIs was 25.73±16.19 days and 16.36±10.28 days for those with colonization (T test, p=0.002). Additionally, the mean dwell time for PICCs infected by non-MDROs was 22.48±15.64 days whereas for PICCs with MDROs, it was 17.38±9.5 days (T test, p=0.005). In PICCs with CLABSIs, the mean indwelling time for MDR pathogens was 21.50±12.31 days, while for non-MDROs, it was 27.73±16.98 days (T test, p=0.417). In PICCs with colonization, the mean dwell time for MDR pathogens was 15.55±7.73 days, while for non-MDROs, it was 16.92±11.85 days (T test, p=0.124). Among PICCs with MDR pathogens (n=26), the mean duration in CLABSIs events (n=18) was 21.5±12.31 days and in colonization events 15.55±7.73 days, (n=8) (T test, p=0.146). Conclusions: The present study reveals that colonization of PICCs exhibited a shorter dwell time compared to those with CLABSIs. Moreover, PICCs infected by MDROs had a shorter mean dwell time than those with non-MDROs. These findings underscore the importance of considering infection status and microbial resistance patterns when evaluating PICC dwell times.

Background. Cardiorespiratory fitness (CRF) is a predictor of chronic disease that is impractical to routinely measure in primary care settings. We used a new estimated cardiorespiratory fitness (eCRF) algorithm that uses information routinely documented in electronic health care records to predict abnormal blood glucose incidence. Methods: Participants were adults (17.8% female) 20-81 years old at baseline from the Aerobics Center Longitudinal Study between 1979 and 2006. eCRF was based on sex, age, body mass index, resting heart rate, resting blood pressure, and smoking status. CRF was measured by maximal treadmill testing. Cox proportional hazards regression models were established using eCRF and CRF as independent variables predicting the abnormal blood glucose incidence while adjusting for covariates. Results: Of 8,602 participants at risk at baseline, 3,580 (41.6%) developed abnormal blood glucose during an average of 4.9 years follow-up. The average eCRF of 12.03 ± 1.75 METs was equivalent to the CRF of 12.15 ± 2.40 METs within the 10% equivalence limit. In fully adjusted models, the estimated risks were the same (HRs = 0.96), eCRF (95% CIs = 0.93−0.99), and CRF (95% CI of 0.94−0.98). Each 1-MET increase was associated with a 4% reduced risk. Conclusion: Higher eCRF is associated with a lower risk of abnormal glucose. eCRF can be a vital sign used for research and prevention.

The global population is at risk of vitamin D deficiency due to low exposure to sunlight and low intake of the vitamin through diet. The aim was to investigate in women the association between vitamin D status and parathyroid hormone (PTH), ultraviolet radiation, lifestyle, ethnicity, social conditions, and residential greenness. A 1-year longitudinal study assessed vitamin D status in 309 women, latitude 51° 14' N. Blood samples were taken four times throughout the year for analysis of 25(OH)D and serum PTH concentration. After each seasonal visit, the individuals completed 4-day diet diaries and used two dosimeter badges for 1 week to estimate weekly UVR exposure. A questionnaire was applied to provide information about lifestyle and their ethnicity. Residential greenness was measured by Normalized Difference Vegetation Index (NDVI), within a 1000 m radius around each participant’s home address. Women living in greener spaces were more likely to have improved vitamin D status (RR: 1.51; 95%CI: 1.13 – 2.02), as well as those who were more exposed to UVR (RR: 2.05; 95%CI: 1.44 – 2.92). Our results provided a first insight into the connection between vitamin D, residential greenness, and lifestyle in a region of temperate climate and with a high degree of urbanization.

Newborn screening using biochemical tests is a widespread practice. However, the recent availability of genetic sequencing has enabled the rapid screening of many monogenic disorders. The purpose of our study was to assess the outcomes of whole exome sequencing (WES) and whole genome sequencing (WGS) as the primary newborn screening test. This cohort study enrolled 26 symptomatic neonates and infants exhibiting a spectrum of neurological symptoms and issues. Genome sequencing (GS) identified relevant diagnostic variants in 9 patients (point mutations, CNVs and one case of aneuploidy), suggesting that using GS as the primary newborn screening test in a general newborn population enhances traditional screening's detection capabilities. This evidence-based finding may support considering GS as a critical method for first-tier screening.

The platelet count, a component of the full blood count, has been identified as a useful diagnostic marker for cancer in primary care. The reference range for the platelet count is 150 to 400 or 450 × 109/l; this range does not account for natural variation in platelet count by age and sex. This study used three primary care cohorts from England Canada, and Australia. Patients aged 40 years and over with a full blood count were included and stratified by age (in 10-year bands), sex, (male/female), and platelet count group. Cancer incidence within one year of test date was estimated from linked registry data. In all three countries there was a clear upwards trend in cancer incidence with increasing platelet count, for both sexes and at all age groups. Lung and colorectal were the most common sites. These results have important implications for the international application of this work; analysis of local health datasets will be crucial to determine appropriate thresholds. Appropriate upper thresholds will depend on local populations, healthcare needs, and priorities. Further research is needed to assess the likely impact of new recommendations on the healthcare system, on cancer outcomes, and patient benefit.

Background: Modulator therapies improve weight and body mass index (BMI) in cystic fibrosis (CF) patients. We aimed to compare the nutritional risk index (NRI) in adult CF patients receiving modulator (MT) or only non-modulator (conventional) therapies (non-MT). Methods: A single-center prospective cohort study was conducted between June-December 2023. The NRI based on weight gain and albumin was calculated at beginning and end of a 12 weeks period in both groups. This design was pragmatic, since based on individual patient access to MT for 12 weeks. Results: 107 patients were included [mean (SD) age: 23.85 (4.98) years, 54.7% male, 46.7% MT]. In the MT group, mean (SD) weight (kg) and albumin (g/dL) increased significantly [changes: +3.09 (2.74) and +0.17 (0.37); p

Background: Factors that could predict which patients will benefit from Immune Checkpoint Inhibitors (ICIs) are not fully understood. This study aimed to investigate the prognostic value of KRAS biomarker in patients with advanced non-small cell lung cancer (NSCLC) in relation to clinical characteristics, treatment response and PDL1 expression. Patients and methods: The study included 100 patients with NSCLC who received immunotherapy with or without chemotherapy as 1st line treatment. In biopsy samples, the PDL1 biomarker expression rate and somatic mutations of KRAS gene were determined. Results: The mean age of the patients was 67 ± 8 years. Patients were all male and 66% were found with adenocarcinoma whereas 34% with squamous cell carcinoma. The KRAS G12C mutation was found with the highest percentage (73%). In the Kaplan-Meier survival analysis, patients with PDL1&gt;49% in combination with a negative KRAS result had a median survival of 40 months compared to patients with a positive KRAS result (9 months, p&lt;0.05). In addition, patients diagnosed with adenocarcinoma, PDL1&lt;49% and negative KRAS result had a median survival of 39 months compared to patients with a positive result (28 months, p&lt;0.05). Conclusions: Our study suggests that the presence of KRAS mutations in advanced NSCLC patients has a poor prognostic value, regardless of their PDL1 expression values, after receiving immunotherapy as first-line treatment.

Background: Myocarditis is commonly diagnosed in the intensive care cardiology unit (ICCU). No current recommendation nor guideline aids aetiological assessment. Methods: From September 2021 to October 2023, 84 patients with acute myocarditis underwent thorough and systematic serum and blood cell panel evaluations to determine the most common causes of the myocarditis. Results: Of the 84 patients (median age 34 years, range 22–41 years, 79% male), 16 presented with complicated myocarditis. The systematic aetiological assessment revealed that 36% of patients were positive for lupus anticoagulant, 12% for antinuclear antibodies, 8% for anti-heart antibodies, and 12% for anti-striated muscle antibodies. Viral serology did not yield any significant results. After the aetiological assessment, one patient was diagnosed with an autoimmune inflammatory disorder (Still’s disease). T-cell subset analyses indicated that myocarditis severity tended to increase with the T-cell lymphopenia status. Conclusions: A comprehensive, systematic aetiological assessment was of limited value in terms of predicting the clinical or therapeutic outcomes in myocarditis patients presenting to the ICCU.

Background: Hematopoietic cell transplantation (HCT) is an established therapy for hematologic malignancies and serious non-malignant blood disorders. Despite its curative potential, HCT is associated with substantial toxicity and health resource utilization. Effective delivery of HCT requires complex hospital-based care, which limits the number of HCT centers in Canada. In Canada, the quantity, indications, temporal trends, and outcomes of patients receiving HCT are not known. Methods: A retrospective cohort study of first transplants reported to the Cell Therapy Transplant Canada (CTTC) registry between 2000 and 2019. We determined overall survival (OS) and non-relapse mortality (NRM), categorizing the cohort into early (2000-2009) and later (2010-2019) eras to investigate temporal changes. Results: Of 18,046 transplants, 10,475 were allogeneic and 7,571 were autologous. Comparing the two eras, allogeneic transplants increased in number by 22.3%, with greater use of matched unrelated donors in the later era. Autologous transplants increased by 10.9%. Temporal improvements in NRM were observed in children and adults. OS improved in pediatric patients and in adults receiving autologous HCT. In adults receiving allogeneic HCT, OS was stable despite the substantially older age of patients in the later era. Interpretation: HCT is an increasingly frequent procedure in Canada which has expanded to serve older adults. Noted improvements in NRM and OS reflect progress in patient and donor selection, preparation for transplant, and post- transplant supportive care. In allogeneic HCT, unrelated donors have become the most frequent donor source, highlighting the importance of continued growth of volunteer donor registries. These results serve as a baseline measure for quality improvement and health services planning in Canada.

The Mediterranean diet represents one of the most studied dietary patterns, however, there is no single tool for measuring the grade of adherence and no single criteria to adapting these indices to pregnant women. We characterized the adherence to the Mediterranean diet (MDA) of pregnant women participating in the NELA cohort and identified the sociodemographic determinants and lifestyle habits associated with a higher risk of a low MDA. Maternal diet during gestation was assessed by a validated Food Frequency Questionnaire (FFQ) (n=665). We estimated Relative Mediterranean Diet score (rMED), Alternative Mediterranean Diet score (aMED) and Alternate Healthy Index-2010 (AHEI-2010). Multivariate regression models were performed to identify the sociodemographic and lifestyle factors associated to each index. Mothers with lower age and more previous deliveries had a greater probability of low MDA (P &lt;0.05). Only, for aMED index, mothers with university education and / or who practiced 2 or more hours per week sport activities had a lower probability of a low MDA (P &lt;0.01). These results may be useful in order to design intervention strategies and dietary recommendation for pregnant women.

Poor therapeutic outcomes have been attributed to inter-individual and interethnic variability in cytochrome P450 (CYP450)-dependent metabolism and altered drug retention associated with P-glycoprotein (P-gp). An individualized pharmacotherapeutic approach would benefit the genetically diverse South African population. The study aim was to develop a validated, targeted, analytical method to quantify seven probe drugs and their metabolites in dried blood spots (DBS) using the Mitra™ volumetric absorptive micro-sampling device for blood collection. An Agilent liquid chromatography (LC) system coupled to a Sciex 4000 QTRAP tandem mass spectrometer (MS) was used for method optimization and validation. Targeted LC-MS/MS methods were validated according to ICH guidelines. The validated LC-MS/MS method met the required bioanalytical standards for specificity, sensitivity, linearity, accuracy, precision, carry-over, and stability. This study successfully validated the use of DBS, collected with the Mitra™ microsampling device, to measure expected probe drug and metabolite concentrations using the “Geneva phenotyping cocktail” for the purpose of simultaneous phenotyping of in vivo CYP450 metabolic activity of the CYP1A2, -2B6, -2C9, -2C19, -2D6, and -3A4 enzymes, and P-gp transport activity. However, statistical analysis using Bland-Altman plots showed that not all analytes exhibited linear distribution pharmacokinetics between DBS and plasma, which influenced the predicted vs real plasma concentrations based on measurements in a DBS matrix. These findings were attributed to the blood-to-plasma concentration ratio, the physicochemical properties and stability of the analytes, and the extraction efficiency of the Mitra™ sampler. More research is required before DBS sampling can be substituted for conventional plasma sampling

Long COVID–19 syndrome is another vicious feature of COVID-19 infection, the mechanism remains unidentified. Several observational studies suggest that vaccinations might have protective and therapeutic effect on long COVID-19 and our study aimed to assess the influence of vaccination on COVID-19 patients. We performed an observational cohort study from October 2020 to July 2022, which included 503 patients (291 males and 212 females) with a median age of 65. They were hospitalized due to COVID-19 pneumonia and had persistent symptoms (after 1 month of COVID-19 infection. The clinical and demographic data including vaccination status collected during hospitalization and regular visits at the Community Healthcare Center dr. Adolf Drolc Maribor were analyzed. More non-vaccinated patients acquired long COVID-19 than vaccinated. Patients with type 2 diabetes suffered from long COVID-19 in a smaller percentage than patients without diabetes. Gender, inhalational therapy due to chronic pulmonary disease and the number of complications have significantly influenced long COVID-19 development and the mostly vaccinated patients were older and with asthma/COPD. Our study confirmed that vaccination is a safe and effective measure to prevent the severe progression of acute disease and to lower the incidence of developing long COVID.

Aim: In individuals with COVID-19, the study assessed the relationship between cytokine expression and pulmonary dysfunction. These correlations may help to suggest strategies for prevention and therapies of coronavirus disease outbreak. Patients and methods: 50 healthy participants and 100 COVID-19 patients participated in this study. COVID-19 participants were subdivided into moderate and severe groups based on the severity of their symptoms. In both patients and controls, measurements of white blood cells (WBCs), lymphocytes, C-reactive protein (CRP), interleukin (IL)-1, IL-4, IL-6, IL-18, and IL-35 were estimated. All the patients performed chest CT and CO-RADS score was assessed. Results: All patients had increased WBCs count and CRP, IL-1, IL-4, IL-6, IL-18, and IL-35 levels than healthy controls. While WBCs, CRP, and cytokines like IL-1β and IL-6 showed significantly higher levels in the severe group as compared to moderate patients, IL-4, IL-35, and IL-18 showed comparable levels in both disease groups. Furthermore, CO-RADS score was positively connected with WBCs, CRP, and cytokine levels (IL-35, IL-18, IL-6, IL-4 and IL-1β) in both groups, and lymphocyte levels in all patient groups considerably decreased as compared to the controls. CO-RADS score, also demonstrated a positive correlation with lymphocytes in the moderate COVID-19 patients, whereas in the severe patients, it demonstrated a negative correlation with lymphocytes. Conclusion: Severe COVID-19 patients, compared to individuals with moderate illness and healthy controls, patients had lower lymphocyte counts and increased CRP with greater WBCs counts. In contrast to moderate COVID-19 patients, severe COVID-19 patients had higher levels of IL-1β and IL-6, but IL-4, IL-18, and IL-35 between both illness categories at close levels. CO-RADS 5 was the most frequent category in both moderate and severe cases. Patients with a typical CO-RADS involvement had a higher CRP and white blood cell count with a lower lymphocyte count than the others. Cytokine levels were considered a surrogate markers of severe lung affection in COVID 19 patients.

Prior research shows that individuals who have exhibited antisocial behavior are in poorer health than their same-aged peers. A major driver of poor health is aging itself, yet research has not investigated relationships between offending trajectories and biological aging. We tested the hypothesis that individuals following a life-course persistent (LCP) antisocial trajectory show accelerated aging in midlife. Trajectories of antisocial behavior from age 7 to 26 years were studied in the Dunedin Multidisciplinary Health and Development Study, a population-representative birth cohort (N=1037). Signs of aging were assessed at age 45 years using previously validated measures including biomarkers, clinical tests, and self-reports. First, we tested whether the association between antisocial behavior trajectories and midlife signs of faster aging represented a decline from initial childhood health. We then tested whether decline was attributable to tobacco smoking, antipsychotic medication use, debilitating illnesses in adulthood, adverse exposures in childhood (maltreatment, socioeconomic disadvantage) and adulthood (incarceration), and to childhood self-control difficulties. Study members with a history of antisocial behavior had a significantly faster pace of biological aging by midlife, and this was most evident among individuals following the LCP trajectory (β, .22, 95%CI, .14, .28, p.001). This amounted to 4.3 extra years of biological aging between ages 25-45 years for Study members following the LCP trajectory compared to low-antisocial trajectory individuals. LCP offenders also experienced more midlife difficulties with hearing (β, -.14, 95%CI, -.21, -.08, p.001), balance (β, -.13, 95%CI, -.18, -.06, p.001), gait speed (β, -.18, 95%CI, -.24, -.10, p.001), and cognitive functioning (β, -.25, 95%CI, -.31, -.18, p.001). Associations represented a decline from childhood health. Associations persisted after controlling individually for tobacco smoking, antipsychotic medication use, midlife illnesses, maltreatment, socioeconomic status, incarceration, and childhood self-control difficulties. However, the cumulative effect of these lifestyle characteristics together explained why LCP offenders have a faster Pace of Aging than their peers. While older adults typically age-out of crime, LCP offenders will likely age-into the healthcare system earlier than their chronologically same-aged peers. Preventing young people from offending is likely to have substantial benefits for health, and people engaging in a LCP trajectory of antisocial behaviors might be the most in need of health promotion programs. We offer prevention and intervention strategies to reduce the financial burden of offenders on health care systems and improve their wellbeing.

ABSTRACT Objectives: To investigate the effect of individual-level, neighborhood, and environmental variables on uterine fibroid (UF) prevalence in a Chicago-based cohort. Methods: Data from the Chicago Multiethnic Prevention and Surveillance Study (COMPASS) were analyzed. Individual-level variables were obtained from questionnaires, neighborhood variables from the Chicago Health Atlas, and environmental variables from NASA satellite ambient air exposure levels. The Shapiro-Wilks test, logistic regression models, and Spearman’s correlations were used to evaluate the association of variables to UF diagnosis. Results: We analyzed 602 participants (mean age: 50.3±12.3) who responded to a question about UF diagnosis. More Black than White participants had a UF diagnosis (OR, 1.32; 95% CI, 0.62–2.79). We observed non-significant trends between individual-level and neighborhood variables and UF diagnosis. Ambient air pollutants, PM2.5 and DSLPM were protective against UF diagnosis (OR 0.20, CI: 0.04–0.97: OR 0.33, CI: 0.13–0.87). Conclusions: Associations observed within a sample in a specific geographic area may not be generalizable and must be interpreted cautiously.

Background: Hidradenitis Suppurativa (HS) is characterized by inflamed lesions that appear in apocrine rich flexural areas. Although studies have reported clinical and epidemiological data from western countries, data from the Middle East are scarce. The aim of this study is to characterize the differences in the clinical characteristics of patients with HS of Arab and Jewish ancestry and to review the clinical characteristics, the course of the disease, the comorbidities and the response to treatment. Methods: This is a retrospective study. We collected clinical and demographic data from patient files at the Rambam Healthcare Campus dermatology clinic – a tertiary hospital located at the north of Israel. between 2015-2018. Our results were compared to those of a previously published Israeli control group registered in clalit health services. Results: Of the 164 patients with HS, 96 (58.5%) were men and 68 (41.5%) were women. The average age at diagnosis was 27.5 years and the latency between the onset and diagnosis of the disease was 4 years. we found a higher adjusted prevalence of HS in Arab patients (56%) than in their Jewish counterparts (44%). Gender, smoking and obesity, as well as axilla and buttock lesions, were risk factors for severe HS, with no differences between ethnicities. No differences were documented in comorbidities and in response to Adalimumab, with a high overall response rate of 83%. Conclusions: Our findings revealed differences between Arab and Jewish patients with HS in terms of incidence and gender predominance, while no differences were documented in comorbidities and response to Adalimumab.

Abstract: Purpose: High-grade isthmic spondylolisthesis (HGISL) is a severe condition, associated with low-back pain (LBP) and radiculopathies. The present study is a monocentric prospective observational study investigating the clinical-radiological outcomes of a bilateral minimally invasive TLIF (bm-TLIF) for HGISL. Material and Methods: Patients who underwent bm- TLIF for HGISL at our institution, were considered for inclusion. Clinical-radiological outcomes and complications were collected. Results: Twenty-one patients (14M:7F) were included and the mean clinical follow-up (FU) time was 27(±6) months. There was a significative improvement of the mean VAS-back, VAS-legs, ODI, and SF-36 PCS scores, comparing pre- and last FU measurements. The mean pelvic tilt (p0,05). The univariate analysis showed that residual slip angle (> or  10°) may independently influence VAS-b (p

Aim: To determine the prevalence of skeletal muscle alterations (SMA) in patients with meta-bolic dysfunction-associated steatotic liver disease (MASLD) and to assess the significance of circulating myokines as potential biomarkers of SMA in patients with MASLD. Material and methods: Measurements of both skeletal muscle strength and skeletal muscle mass parameters, anthropometric and metabolic features as well as serum levels of different myokines were per-formed in a cohort of 62 MASLD patients and then compared according to the stage of liver fi-brosis and hepatosteatosis degree both diagnosed by transitional elastography. Results: No sig-nificant differences were found in skeletal muscle strength and skeletal muscle mass in MASLD patients stratified according to the stage of liver fibrosis. Noteworthy, serum levels of FGF21 were significantly higher in MASLD patients with advanced hepatic fibrosis (F3-F4) than in those with lower stages of hepatic fibrosis (F0-F2) (197.49±198.27 pg/ml vs 95.62±83.67 pg/ml, p=0.049, respectively). MASLD patients with severe hepatosteatosis (S3) had significantly higher serum levels of irisin (1116.87±1161.86 pg/ml) than those with lower grades (S1-S2) (385.21±375.98 pg/ml, p=0.001). Conclusion: SMA were uncommon in our MASLD patients, particularly in those with lower stages of liver fibrosis. An increase in serum FGF21 was detected in patients with a higher stage of fibrosis with possible therapeutic implications in MASLD.

Background: Only few pediatric reports exist regarding the prevalence, cause and evolution of liver and renal injury in patients with anorexia nervosa (AN). The aim of this study is to describe the prevalence and the risk factors of hepatic and renal failure at admission and during hospitalization, especially during refeeding in a cohort of hospitalized adolescents with AN.Methods: In a retrospective cohort study of adolescents with AN in a single hospital of Marseille from 2013 to 2019, we compared four groups on admission: elevated aminotransferases (AT)/normal AT and renal injury/no renal injury to analyze the differences between them (demographic factors, anthropometric factors, disease duration, initial prescribed calories, speed of refeeding, aminotransferase level, glomerular filtration rate). We observed the evolution of AT and renal injury for these four groups during refeeding (by the increase of kilocalories). Results: A total of 29 subjects with AN met eligibility criteria (age: 14.2 years, female (86.2%), BMI at admission (Z-score= -2.8 standard deviation (SD)) with elevated AT (20.7 %) and renal injury (13.8 %) on admission. Lower Z-score BMI (-4.05 vs -2 SD, p = 0.013), lower expected weight for height (69% vs 76%, p = 0.034) and longer disease duration (2.1 vs 0.9 years, p =0,032) were significantly associated with elevated liver enzymes at admission. Lower Z-score BMI (-3.35 vs -2.5 SD, p = 0.002), lower expected weight for height at admission (69% vs 74,5%, p = 0.002) and loss of weight before admission (0.66 vs à 0.20 kg per day, p = 0.002) were associated with renal injury at admission. Time nadir BMI (13.5 vs 6.5 days, p = 0.034) and duration of hospitalization (55 vs 41 days, p = 0.036) were longer in elevated enzymes on admission group. During refeeding, liver enzymes (95% confidence interval (CI), odds ratio (OR) aspartate aminotransferase: -0.07 [-0.11; -0.03] and OR alanine aminotransferase: -0.16 [-0.27; -0.06]) and renal injury (95% CI, OR creatinine: -0.013 [-0.017; -0.008]) have normalized with the increase of calories, with significant association.Conclusions: The results of this study suggest that degree of malnutrition is associated with liver and renal injury on admission. Theses failures disappeared with refeeding. In the future, prospective multicentric studies could examine evolution of renal and hepatic failure undergoing refeeding in large pediatric cohort of AN.

While obesity is a serious chronic condition, its prevalence and documentation as a diagnosis has not been extensively studied in hospitalized patients. We conducted a retrospective chart review to investigate the prevalence and documentation of obesity as a diagnosis among patients admitted to our medical center. IRB approval was obtained for this retrospective study. Body mass index as per CDC, admission and discharge diagnosis of obesity and common comorbidities including hypertension, diabetes, hyperlipidemia and others, were recorded. Length of hospital stay was calculated. We also investigated whether counselling for weight loss was provided to obese patients. A total of 540 consecutive patients with mean age of 66 ± 6 years, were investigated, of which 182(34%) had normal weight, 188(35%) patients were overweight and 170(31%) patients were obese. Obese group included 55% female and 45% male. 100 (59%) had class I obesity, 43(25%) had class II obesity and 27(16%) class III obesity. Of the obese patients 40/170(23.5%) patients had obesity documented on the admission problem list and only 21(12%) had obesity documented as a discharge diagnosis. Only 3(2%) patients received appropriate counseling and referral for obesity management during the hospitalization. Comorbidities included hypertension (68%), diabetes (35%), hyperlipidemia (36%), coronary artery disease (18%), chronic kidney disease (17%), congestive heart failure (18%) and COPD (24%). The average length of stay in normal weight, overweight and obese patients was similar (4.5 ± 0.5 days). An overwhelming percentage never had weight status documented despite significant prevalence of obesity. Hospitalization offers health care providers a window of opportunity to identify obesity, communicate risks and initiate weight management interventions.

C-C motif chemokine ligand 2 (CCL2), also called monocyte chemoattractant protein-1 (MCP-1) is a key β-chemokine involved in the migration of monocytes and macrophages, playing a significant role in the inflammatory responses in the airways. We aimed to assess the serum levels of MCP-1/CCL2 in a pilot cross-sectional study of Bulgarian children with bronchial asthma (BA) and cystic fibrosis (CF). Forty-two children were recruited to the study as follows: twenty with BA, twelve with CF and ten healthy children. Serum MCP-1/CCL2 levels were measured using ELISA. We found higher serum level of MCP-1/CCL2 in children with BA (191.09±64.96 pg/ml) and CF (258.51±76.45 pg/ml) compared to healthy children (70.30±64.30 pg/ml, p=0.022, and p=0.068, respectively). Younger patients with BA had higher levels of MCP-1/CCL2, as well as children with CF, with levels decreasing gradually with age. We observed also higher levels of MCP-1/CCL2 in children with moderate to severe BA compared to mild BA. We documented the significantly higher level of MCP-1/CCL2 in children with these chronic pulmonary diseases than in healthy controls, which suggesting that investigation of serum MCP-1/CCL2 levels could turn out to be beneficial for the severity of the disease.

Background: In 1962, Susser and Stein observed that the mortality rates of peptic ulcers in England and Wales increased markedly in the 1910s, maintained at a high level during the 1910s-1940s, and began to decline steadily since the early 1950s. They termed this epidemic pattern a birth-cohort phenomenon, but its mechanism has never been elucidated. Susser and Stein speculated that the occurrences of extraordinary social environmental factors roughly fit the fluctuations, but the role of environmental factors in peptic ulcers has never been identified. Objectives: This study aims to elucidate the mechanism of the birth-cohort phenomenon of peptic ulcers and identify the role of environmental factors in the disease. Methods: Starting from an etiology identified recently, this study uses the two inverse operations in calculus, differentiation, and integration, to analyze the existing data. First, a fluctuation curve in the birth-cohort phenomenon is differentiated into multiple annual mortality rates caused by individual environmental factors. Second, these annual mortality rates are integrated to reproduce the fluctuation curve in the birth-cohort phenomenon. Results: The differentiation reveals a parallel relationship between the psychological impacts of environmental factors and the mortality rates of peptic ulcers, whereas the integration reproduces a representative fluctuation curve in the birth-cohort phenomenon. The successive occurrences of multiple social environmental factors from the 1910s to 1940s maintained the increase in mortality rates, while the sustained improvements in living environments explained the steady decline of the mortality rates from the early 1950s. Conclusion: The parallel relationship suggests a causal role of environmental factors in peptic ulcers, whereas the reproduction of a representative fluctuation curve indicates that multiple environmental factors caused the birth-cohort phenomenon by Superposition Mechanism. Significantly, this study challenges the current reductionist approach used to study disease in modern medicine by demonstrating the effectiveness of an opposite methodological concept focused on integration.

Objective: To describe the proportion of patients undergoing major abdominal surgery who develop postoperative hypothermia, and the variables associated with its occurrence. Material and Methods: We conducted a prospective cohort study in a tertiary care referral hospital in Mexico City to describe the incidence of perioperative hypothermia and factors associated with postoperative hypothermia. A repeated measures ANOVA model was used to compare preoperative, intraoperative, and postoperative temperatures. Potential variables associated with hypothermia were evaluated with a logistic regression analysis. Results: A total of 110 patients were included in the analysis. Of them, 61% (n=67) were women. The mean age was 56.7 years (SD: 16.3, range: 75). The most frequently involved organ on which surgery was performed was kidney or urinary tract (21.8%), followed by large bowel (14.5%) and exploratory laparotomy (14.5%). The incidence of postoperative hypothermia in patients undergoing major abdominal surgery was 57.3%, while preoperative and intraoperative hypothermia occurred in 55.5% and 79.1%, respectively. Age over 60 years was the only variable associated with postoperative hypothermia after multivariable adjustment for sex, age, and time surgery (OR=18.4, 95% CI:3.79-89.6, p<0.0001). Conclusion: Increasing age was the only variable associated with postoperative hypothermia in patients undergoing major abdominal surgery.

Hydrotherapy, including the use of therapeutic showers and bathtubs, has been studied for its potential benefits in labor pain management. Previous research has indicated that hydrotherapy can alleviate pain, but comparative studies between therapeutic showers and bathtubs are scarce. Objective: This study aims to compare the effects of therapeutic showers and bathtubs on pain perception, labor duration, use of epi-dural analgesia, and maternal and neonatal outcomes during labor. Methods: A total of 124 pregnant women were included in this study. Participants were divided into two groups: those who used a thera-peutic shower and those who used a bathtub during labor. Pain levels were measured using a visual analog scale (VAS). Labor duration, use of epidural analgesia, types of delivery, maternal outcomes (postpartum hemorrhage, perineal status, maternal hypotension, fever, and breastfeeding), and neonatal outcomes (APGAR scores, fetal heart rate, complications, and neonatal unit admissions) were recorded and analyzed. Results: Both the therapeutic shower and the bathtub effectively reduced pain perception, with the bathtub showing a greater reduction in VAS scores. The therapeutic shower group experienced a signifi-cantly shorter labor duration compared to the bathtub group. The majority of participants in both groups did not require epidural analgesia, with no significant differences between the groups. There were no sig-nificant differences in the types of delivery. Maternal outcomes indicated a lower incidence of perineal tears and episiotomies in the therapeutic shower group. Neonatal outcomes, including APGAR scores and fetal heart rate, were similar between the groups, with no significant differences in complications or neo-natal unit admissions. Conclusions: Both therapeutic showers and bathtubs are effective for pain relief during labor, with the bathtub showing a higher reduction in pain intensity. The therapeutic shower is as-sociated with a shorter labor duration and a lower incidence of perineal tears and episiotomies. Both meth-ods are safe for neonatal well-being, making hydrotherapy a viable non-pharmacological option for pain management in labor. However, the therapeutic shower may offer additional benefits in terms of labor du-ration and maternal outcomes.

We aimed to assess the caffeine intake before and during pregnancy, compliance with caffeine recommendations during pregnancy (200 mg/day) and factors associated with higher intakes before and in first trimester of pregnancy. Caffeine consumption was collected in a Spanish cohort of pregnant women through a validated food questionnaire, before and in each trimester of gestation (T1, T2 and T3). 463 pregnant women were recruited and follow-up through pregnancy. Compliance with caffeine intake recommendations during pregnancy and quintiles of mg/day of caffeine before and in T1 of pregnancy were calculated. A multivariate logistic regression, comparing extreme quintiles of consumption (Q1 vs Q5) was used. Mean caffeine intake before pregnancy was 120.05 mg/day (SD 117.85), 42.76 mg/day (SD 63.90) at 12th GW, 42.00 mg/day (SD 59.76) at 24th GW and 39.34 mg/day (SD 50.9) at 32nd GW (p&lt;0.001). 86% of women complied with caffeine recommendations during pregnancy. At pregnancy (T1), being an active smoker was associated with Q5 &gt; 100.1 mg/day, aOR = 22.69; 95% CI 4.67- 110.26. igh diet quality, aOR = 0.30; 95% CI, 0.13- 0.68, and moderate physical activity level, aOR= 0.44; 95% CI, 0.19-1.00, were inversely associated with Q5 &gt; 100.1 mg/day. Pregnant women are mostly adhering to current caffeine intake guidelines. Higher caffeine intake at pregnancy is associated with other unhealthy habits during pregnancy.

Our goal was to determine the cellular immune response (CIR) among a random sample of the Borriana COVID-19 cohort (Spain) to identify its associated factors and their relationship with infection, reinfection and sequelae. We conducted a nested case-control study using a randomly selected sample of 225 individuals age 18 and older, including 36 individual naïve to SARS-CoV-2 infection, and 189 infected patients. We employed flow cytometry-based immunoassays for intracellular cytokine staining, utilizing Wuhan and BA.2 antigens and chemoluminescence microparticle immunoassay for detection SARS-CoV-2 antibodies. Logistic regression models were used. A total of 215 (95.6%) participants exhibited T-cell response (TCR) to at least one antigen. Positive responses of CD4+ and CD8+ T cells were 89.8% and 85.3% respectively. No difference in CIR was found for naïve and infected patients. Patients who experienced sequelae exhibited higher CIR than those without. A positive correlation was observed between TCR and Anti-Spike IgG levels. Factors positive associated with TCR included A-blood group, number of SARS-CoV-2 vaccine doses received, and Anti-N IgM; factors inversely related were the time elapsed since the last vaccine dose or infection, and B-blood group. These findings contribute valuable insights into the nuance immune landscape shaped by SARS-CoV-2 infection and vaccination.

Hypertrophic cardiomyopathy (HCM) is a common inherited cardiac disorder characterized by marked clinical and genetic heterogeneity. Ethnic groups underrepresented in studies may have distinctive characteristics. We sought to evaluate the clinical and genetic landscape of Russian HCM patients. A total of 193 patients (52% male; 95% Eastern Slavic origin; median age 56 years) were clinically evaluated, including genetic testing, and prospectively followed to document outcomes. As a result, 48% had obstructive HCM, 25% had HCM in family, 21% were asymptomatic, and 68% had comorbidities. During 2.8 years of follow-up, the all-cause mortality rate was 2.86%/year. A total of 5.7% received an implantable cardioverter-defibrillator (ICD), 21% septal reduction therapy. Sequencing analysis of 176 probands identified 64 causative variants in 66 patients (38%); recurrent variants were MYBPC3 p.Q1233* (8), MYBPC3 p.R346H (2), MYH7 p.A729P (2), TPM1 p.Q210R (3) and FLNC p.H1834Y (2); 10 were multiple variant carriers (5.7%); 5 had non-sarcomeric HCM, ALPK3, TRIM63 and FLNC; thin filament variant carriers had a worse prognosis for heart failure (HR = 7.9, p=0.007). In conclusion, in the Russian HCM population, the low use of ICD and relatively high mortality should be noted by clinicians; some distinct recurrent variants are suspected to have a founder effect; family studies on some rare variants enriched the worldwide knowledge in HCM.

Background: Cardiovascular disease (CVD) increases the risk of mortality and morbidity in patients with rheumatoid arthritis (RA). Patients with RA have a 50-60% increased risk for CVD compared with the general population. Cardiovascular risk is commonly meas-ured using the Systemic Coronary Risk Estimation 2 calculator modified for patients with RA. Traditional modifiable risk factors for CVD include arterial hypertension, dyslipidemia, insulin resistance, diabetes, cigarette smoking, and low physical activity. In this study, we analyzed the effects of smoking and the risk of CVD in patients with RA. Methods: This was a prospective, clinical, cohort study with an eight-year follow-up pe-riod. A total of 201 patients, 124 with RA (study group) and 77 with osteoarthritis (OA) (control group), were included in this study. However, only 137 patients (82 with RA and 55 with OA) completed the study. Fifty-eight patients (41 with RA and 17 with OA) died during the study period. We compared the prevalence of smoking and its association with the risk for CVD and RA. Results: The prevalence of smoking in the RA group was higher than that in the OA group (p<0.0001). Trends in the prevalence of smoking in both groups did not change signifi-cantly during the follow-up period. In the RA group, smoking was associated with the in-cidence of CVD in current smokers (p=0.028) and in patients with a history of smoking (p=0.016). These results suggest that smokers have an increased risk for RA. The trend of continued smoking in patients with RA may be attributed to attempts to reduce stress caused by RA symptoms. Conclusions: Previous studies have shown that current and former smokers with RA have more severe symptoms, more joint damage, and poorer response to therapy than those who have never smoked. However, the reason underlying the trend of continued cigarette smoking in patients with RA remains unclear. Further studies are needed to clarify the trend of continued smoking in patients with RA.

Eosinophilic Granulomatosis with Polyangiitis (EGPA) is a rare systemic necrotizing vasculitis, affecting small-to-medium sized vessels. EGPA’s clinical manifestations are heterogeneous affecting different organs and systems and the upper respiratory tract can be affected with Ear, Nose and Throat (ENT) involvement. The aim of our study was to assess type manifestations at time of diagnosis in a cohort of EGPA patients and correlate findings with baseline variables (sex, age, antineutrophil cytoplasmic antibodies –ANCA- status) and literature reports. Main ENT manifestations in our patients at time of diagnosis were: nasal polyposis (CRSwNP) (52%), turbinate hypertrophy (48%), nasal swelling (40%), rhinorrhoea (40%), chronic rhinosinusitis without nasal polyposis (CRSsNP) (32%), nasal bone deformities (32%), nasal crusts (20%), nasal mucosal ulcers (12%), corditis (12%), hoarseness/dysphonia (12%), hearing loss (12%), mucoceles(4%) eosinophilic rhinitis (4%). No correlations were found between sex, age, ANCA status and ENT clinical manifestations. A polymorphic ENT involvement is often observed at early stages of EGPA. The presence of nasal, sinus, ear and/or laryngeal manifestations in patients with asthma and hypereosinophilia, independently of sex, age or ANCA status, should raise allert for further investigation and differential diagnosis for EGPA. ENT specialists should be aware of their leading position in this diagnostic race.

Increasing evidence supports the direct healing effects of forests, partly attributed to the exposure to plant-emitted monoterpenes available in the forest atmosphere. The potential benefits on respiratory functions from inhaling monoterpenes have gained attention, especially due to the global rise in respiratory diseases. This study involved 42 asthmatic adolescents attending a summer rehabilitation camp at an Altitude Pediatric Asthma Center within a densely forested area in the Eastern Italian Alps. Volatile organic compound measurements indicated a pristine atmosphere, enabling modeling of continuous hourly monoterpenes concentration. Monoterpene concentration exposure and total inhaled dose were assessed over a 14-day stay, during which spirometry, lung oscillometry, and fractional exhaled nitric oxide were measured. Statistically significant correlations were observed between modifications in lung function parameters among asthmatic adolescents and monoterpenes exposure. These findings suggest a potential localized airway effect specific to monoterpenes. This pilot cohort study might pave the way for further investigations into the therapeutic effects of forest monoterpenes on lung function tests, asthma, and the broader healing potential of forest environments.

Lead exposure is associated with poor cognitive development in children. Very few studies in sub-Saharan Africa (SSA) have studied blood lead levels (BLLs) and non-gasoline sources of exposure in children. Data from a birth cohort in Benin (2011-2013) suggested that 58% of one-year-old children had BLLs > 50 ug/L. We aimed to investigate the prevalence of elevated BLLs (>50 µg/L and >100 µg /L) among 425 of these children at six-years-of-age in 2016-18 and to compare BLLs between age one-year and six-years and study sources of lead at six years. BLLs were analyzed by inductively coupled plasma mass spectrometry. Multiple linear regression and quantile regressions were used to study potential sources of lead. The prevalence of BLLs >50 µg/L in children was 59.5% [Geometric Mean (GM) 56.4 µg/L, 95% CI: 54.1 - 58.7] at six years of age compared to 54.8% [GM 56.5 µg/L, 95% CI: 53.4-59.6] at one year of age. The prevalence of children with BLLs >100 µg/L decreased from 14.4% at one year of age to 8.2% at six years of age. After adjustment for all other covariates, consumption of peanut more than once per month was significantly associated with a 22.0% (95% CI: 4.6, 42.5) increment in BLLs at six years compared with no consumption. Consumption of bushmeat killed by lead bullets at six years was associated with an increase in the higher percentiles of BLLs (P75) compared with the absence of this source. Other potential sources of lead associated with BLLs with marginal significance were consumption of rice, paternal occupational exposure, and the presence of activity with the potential use of lead. This prospective cohort confirms the persistently high prevalence of elevated BLLs in children residing in a rural region in the south of Benin as well as the presence of multiple and continuous sources of lead. These results highlight the need for prevention programs to reduce and eliminate lead exposure in children.

In this study, long-term mortality effects associated with exposure to PM10, PM2.5, BC (black carbon), and NOx were analyzed in a cohort in southern Sweden during the period from 1991‒2016. Participants (those residing in Malmö, Sweden, born between 1923‒1950) were randomly recruited from 1991‒1996. At enrollment, 30,438 participants underwent a health screening, which consisted of questionnaires about lifestyle and diet, a clinical examination, and blood sampling. Mortality data were retrieved from the Swedish national cause of death register. The modeled concentrations of PM10 (particles with an aerodynamic diameter smaller than or equal to 10 µm), PM2.5 (particles with an aerodynamic diameter smaller than or equal to 2.5 µm), BC (black carbon), and NOx (nitrogen oxides) at the cohort participants' home addresses were used to assess air pollution exposure. Cox proportional hazard models were used to estimate the associations between long-term exposure to PM10, PM2.5, BC, and NOx and the time until death among the participants during the period from 1991‒2016. The hazard ratios (HRs) associated with an interquartile range (IQR) increase in each air pollutant were calculated based on the exposure lag windows of the same year (lag0), 1‒5 years (lag1‒5), and 6‒10 years (lag6‒10). Three models were used with varying adjustments for possible confounders including both single-pollutant estimates and two-pollutant estimates. With adjustments for all covariates, the HRs for PM10, PM2.5, BC, and NOx in the single-pollutant models at lag1‒5 were 1.06 (95% CI: 1.02‒1.11), 1.01 (95% CI: 0.95‒1.08), 1.07 (95% CI: 1.04‒1.11), and 1.11 (95% CI: 1.07‒1.16) per IQR increase, respectively. The HRs were in most cases decreased by the inclusion of a larger number of covariates in the models. The most robust associations were shown for NOx, with statistically significant positive HRs in all models. An overall conclusion is that road traffic-related pollutants had a significant association with mortality in the cohort.

Background and Objectives: Treatment for antineutrophil cytoplasmic antibody-associated vasculitis (AAV) must deal with immunosuppression as well as infections associated with compromised immune system, such as tuberculosis (TB). Our aim was to overcome the gap in the literature concerning the risk of incidental TB after diagnosis of AAV. Materials and Methods: This retrospective population-based cohort study was based on the data from the National Health Insurance Research Database in Taiwan. We used a novel algorithm to identify patients with newly diagnosed granulomatous polyangiitis (GPA) or microscopic polyangiitis (MPA) between January 1, 2000 and December 31, 2012. The primary outcome was risk of incidental TB. Cox proportional hazard models were used to evaluate the association between AAV and incidental TB. Results: A total of 2,257 patients with AAV and a propensity-score matched cohort of 9,028 patients were studied. Overall, patients with AAV were at a 1.48x higher risk of contracting incidental TB than were patients in the matched cohort (adjusted HR 1.48; 95% confidence interval [CI], 1.02-2.15). Note that the highest risk of contracting incidental TB was in the first two years following a diagnosis of AAV, with a nearly 1-fold increase in risk (adjusted HR, 1.91; 95% CI, 1.01-3.60). Female AAV patients were 3.24x more likely than females without AAV to develop TB (adjusted HR 3.24; 95%CI, 1.85-5.67). Conclusion: Patients with AAV face an elevated risk of contracting incidental TB, particularly within the first two years after AAV diagnosis. The risk of contracting TB is higher among female AAV patients than among females without AAV.

Suboptimal micronutrient intake in children remains a public health concern around the world. This study examined the relationship between a previously defined dietary carbohydrate quality index (CQI) and the risk of micronutrient intake inadequacy in a pediatric cohort of Spanish preschoolers. Children aged 4-5 years old were recruited at their medical center or at school, and information on sociodemographic, dietary, and life-style variables were collected through a self-administered online questionnaire. Dietary information was obtained from a validated 147-item semi-quantitative food frequency questionnaire. We calculated the CQI and categorized participants in quartiles according to their score. We assessed the intakes of 20 micronutrients and evaluated the probability of intake inadequacy using the Estimated Average Requirement cut-off point. Generalized estimating equations were used to adjust for potential confounders and account for the intra-cluster correlations between siblings. The adjusted proportions of children with inadequate intake of ≥3 micronutrients were 23%, 12%, 11% and 9% in the first, second, third and fourth quartiles of the CQI, respectively. Children in the highest quartile of CQI had 0.22-fold lower odds (95%CI 0.10-0.48) of having ≥3 inadequate micronutrient intakes than their peers in the lowest quartile. These findings reinforce the relevance of carbohydrate quality in children’s diets.

Early debridement and stabilization for pyogenic spondylodiscitis allow early mobilization of the patient and prevent subsequent spinal deformity. Tantalum (Ta) trabecular metal (TM) components have several potential advantages over conventional implant materials, such as its uniformity and structural continuity, strength, low stiffness, high porosity, high coefficient of friction and tantalum trabecular metal enhances the host defense mechanism by increasing leukocyte chemotaxis, phagocytosis, and the bacterial killing rate. A single-stage surgery with a tantalum trabecular metal cage combining two different approaches is sufficient to maintain vertebral stability. This retrospective cohort study included 57 patients, 31 (54%) patients were treated with single-stage debridement and reconstruction with trabecular metal cages, and 26 (45.6%) patients received spine surgery without trabecular metal cages received surgery between January 2018 and March 2021 in our tertiary academic teaching hospital. The CRP values dropped borderline significantly in the TM cage group compared with the non-TM cage group postoperatively. In patients with spondylodiscitis, it is advisable to perform single-stage debridement and reconstruction with a trabecular metal cage, which allows abscess drainage and rapid mobilization, prevents deformity.

Gaucher Disease's (GD) pathophysiology generates anesthetic concerns in Total Hip joint Arthroplasty (THA), and due to its rareness, data on perioperative risks is scarce. This 22-year study at a large reference center addresses anesthetic management and perioperative outcomes in GD. This retrospective-cohort study assessed anesthetic success and safety in 30 THA patients, comparing them with a control-matched group. Data on clinical characteristics, perioperative events, and outcomes were collected. The primary outcome was difficult anesthesia-initiation incidence. Secondary outcomes were difficult intraoperative course and hemodynamic management, and the development of postoperative-complications. The age, sex, weight, body mass index, primary-to-revision hip arthroplasty ratio were similar in both groups. The mean age was 48±13 years. Ten arthroplasties were revision while twenty were primary. There was no significant difference at all-type anesthesia first initiation attempt success. No particular preference by staff anesthetists for general anesthesia or neuraxial procedures was observed. The GD group showed significantly higher mean intraoperative packed red blood cell units administered (0.73 vs 0.18);(p= 0.038)), higher intraoperative and postoperative platelet transfusion incidence (5/30 [16.7%] vs. 0/56 [0.00%];p=0.004) and (3/30 [10%] vs 0/56 [0%];p=0.040) and longer mean recovery-room length-of-stay (426±412 vs 175±140;p=0.004). Postoperative complications were not significantly different.

Abstract Aim: The study aimed to evaluate the clinical laboratory features of moderate and severe COVID-19 patients among a cohort of the Egyptian population. The study also aimed to assess the accuracy—sensitivity, specificity, and area under the curve (AUC) of various detected parameters in predicting the severity of COVID-19 infection. Patients and methods: One hundred diagnosed COVID-19 patients and fifty healthy participants in total were involved in current study. COVID-19 patients were categorized based on how severe their symptoms into two groups. Estimates were made for serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), albumin, lactate dehydrogenase (LDH) and C-reactive protein (CRP) as well as white blood cells (WBCs) count, lymphocytes count, and hemoglobin content (Hb) content. Results: COVID-19 patients displayed increased serum levels of liver enzymes and CRP as well as WBCs count when compared to healthy individuals. On the other hand, Hb content, lymphocytes count, and albumin level fell in all COVID-19 patients. The severe group showed a statistically significant rise in liver enzymes, WBCs, and CRP levels, compared with moderate group. WBCs and lymphocytes counts were closely correlated with age, ALT, LDH, and CRP in all cases. WBCs and lymphocytes counts also had a negative correlation with albumin Level. Additionally, WBCs count, lymphocytes count, LDH activity and CRP level have higher AUC in severe than in moderate cases. WBCs count, LDH activity and CRP level have AUC above 0.80 in the severe group. Conclusion: The current investigation found a significant correlation between WBCs count, lymphocytes count, CRP level and liver injury in COVID-19 patients. WBCs count, lymphocytes count, LDH activity and CRP level were effective indicators for determining the severity of COVID-19.

ANGPTL3 is an important regulator of lipid metabolism. Its inhibition in people with hypercholesteremia reduces plasma lipid levels dramatically. Genome-wide association studies have associated ANGPTL3 variants with lipid traits. Irisin, an exercise modulated protein, has been associated with lipid metabolism. Intracellular accumulation of lipids impairs insulin action and contributes to metabolic disorders. In this study, we evaluate the impact of ANGPTL3 variants on levels of irisin and markers associated with lipid metabolism and insulin resistance. ANGPTL3 rs1748197 and rs12130333 variants were genotyped in a cohort of 278 Arab individuals from Kuwait. Levels of irisin and other metabolic markers were measured by ELISA. Significance of association signals was assessed using Bonferroni-corrected P-values and empirical P-values. The study variants were significantly associated with low levels of c-peptide and irisin. Levels of c-peptide and irisin were mediated by interaction between carrier genotypes (GA+AA) at rs1748197 and measures of IL13 and TG, respectively. While levels of c-peptide and IL13 were directly correlated in individuals with reference genotype, they were inversely correlated in individuals with carrier genotype. Irisin correlated positively with TG which is strong in individuals with carrier genotypes. These observations illustrate ANGPTL3 as a potential link connecting lipid metabolism, insulin resistance and cardioprotection.

Human papillomavirus (HPV) is associated with cellular changes of the cervix leading to cancer, which highlights the importance of vaccination in preventing HPV infections and subsequent cellular changes. Women undergoing treatment (LEEP) for high-grade cervical intraepithelial neoplasia (CIN2+) remain at risk for recurrence. This study assesses the effect of post-conization HPV vaccination on the viral status of women six months post-conization, aiming to evaluate the vaccine's effectiveness in preventing recurrence of CIN2+. A retrospective cohort study was conducted among women in Troms and Finnmark who underwent conization in 2022. Using the SymPathy database and the national vaccination register (SYSVAK), we analyzed the vaccination status and HPV test results of women born before 1991, who had not received the HPV vaccine prior to conization. Out of 419 women undergoing conization, 243 met the inclusion criteria. A significant association was found between post-conization HPV vaccination and a negative HPV test at six months follow-up (ARR = 12.1%, P = 0.039). Post-conization HPV vaccination significantly reduced the risk of a positive HPV test at the first follow-up, suggesting its potential in preventing recurrence of high-grade cellular changes. The retrospective design and the insufficient control of confounding variables underscore the necessity for further studies to confirm these findings.

This prospective cohort study aimed to evaluate the efficacy of COVID-19 vaccine schemes, ho-mologous versus heterologous vaccine strategies, and vaccine-induced anti-S-RBD-IgG antibody response in preventing COVID-19 among 942 healthcare workers one year after vaccination with the inactivated and/or mRNA vaccines. All participants received the first two primary doses of vaccines, 13.6% of them lacked the dose-3, 50.5% the dose-4, and 90.3% the dose-5. Antibody lev-els increased with the increase in number of vaccine doses and also in heterologous vaccine regi-mens. In both inactive and mRNA vaccines, infection rates were significantly higher in 2-dose-receivers, but lower in 4- or 5-dose receivers and increasing the total number of vaccine doses resulted in more protection against infection: the 3-dose regimen yielded 4.71 times more protection, the 4-dose 11.76 times and 5-dose 38.46 times more protection from COVID-19 infec-tion, compared to any 2-dose vaccination regimens. Antibody levels at the end of the first year of 4- or 5-dose-receivers were significantly higher than 2- or 3-dose-receivers. To conclude; increased number of total vaccine doses and anti-S-RBD antibody levels increased the protection from COVID-19 infection. Therefore, four or more doses are recommended in one year, for effective protection, especially in risk groups.

Introduction: Digitalis use in patients with severe heart failure is controversial. We assessed the effects of digitalis therapy on mortality in a large, observational study in recipients of cardiac resynchronization therapy (CRT). Methods: Consecutive patients receiving a CRT-defibrillator in three European tertiary referral centers were enrolled and followed for a median of 28 months. Digitalis use was assessed at the time of CRT implantation. Multivariate Cox-regression model and propensity score matching was used to determine all-cause mortality as primary endpoint. CRT-response (defined as improvement of ≥1 NYHA class), echocardiographic improvement (defined as improvement of LVEF of ≥ 5%), and ICD shocks were assessed as secondary endpoints. Results: The study comprised 552 CRT recipients with standard indications, including 219 patients (40%) treated with digitalis. Compared to patients without digitalis, they had more often atrial fibrillation, poorer LVEF and higher NYHA class (all p ≤ 0.002). Crude analysis of all-cause mortality demonstrated a similar relative risk of death for patients with and without digitalis (HR=1.14; 95% CI 0.88-1.5; p=0.40). After adjustment for independent predictors of mortality, digitalis therapy did not alter the risk for death (adjusted HR=1.04; 95% CI 0.75-1.45; p=0.82). Also, in comparison to 286 propensity score matched patients, mortality was not affected by digitalis intake (propensity adjusted HR=1.11; 95% CI 0.72-1.70; p=0.64). CRT response was predominant in digitalis non-users concerning both improvement of HF symptoms and LVEF (NYHA p<0.01; LVEF p<0.01) while patients on digitalis had more often ventricular tachyarrhythmias requiring ICD shock (p=0.01). Conclusions: Digitalis therapy had no effect on mortality but did negatively affect CRT response and susceptibility to ventricular arrhythmias requiring ICD shock treatment.

Background and objectives: Huntington disease (HD) is characterized by motor, cognitive and psychiatric manifestations and is caused by an expansion of CAG repeats over 35 triplets on the huntingtin (HTT) gene. However, expansions in the range 27-35 repeats (intermediate allele) can be associated with pathological phenotypes. The onset of HD is conventionally defined by the onset of motor symptoms, but psychiatric disturbances can precede the motor phase by up to twenty years. The aims of the present study are to identify HD patients in the pre-motor phase of the disease among patients diagnosed with bipolar disorders and to evaluate any differences between bipolar patients carrying normal HTT allele and patients with expanded HTT gene. Methods: We assessed the HTT genotype in an Italian cohort of 69 patients affected by bipolar disorder type 1 and type 2. Results: No patient was found to be a carrier of the pathological HTT allele, but 10% of bipolar subjects carried an intermediate allele. Carriers of the intermediate allele were older at onset of psychiatric symptoms than non-carriers. Conclusion: The pathological HTT gene was not associated with bipolar disorder, while we found a higher frequency of the intermediate allele among the bipolar population with respect to healthy controls.

Purpose: To report the progression of patients diagnosed with birdshot chorioretinopathy (BSCR) initially treated with corticosteroids. Methods: We included 39 BSCR patients followed for ≥1 year. Patients were classified into 2 groups according to their initial treatment: methylprednisolone followed by prednisone (n=28) and prednisone alone (n=11). We analyzed the progression under treatment after 1, 3, 6 months, 1 year, and at the end of follow-up. Results: At the end of follow-up, 31/39 (79.5%) patients had reached inflammation control. Thirteen out of 28 (46.4%) and 6/11 (54.5%) patients were treated exclusively with corticosteroids, and 18/19 (94.7%) of them had reached inflammation control at the end of follow-up; their mean (range) corticosteroid dose was 3.5 (0-10) mg/day. Conclusion: We found that the prolonged corticosteroid therapy treatment strategy resulted in inflammation control in half of BSCR patients. This control was maintained with low doses of cortisone, usually <5 mg/day.

Immersive experiences in green areas and particularly in forests have long been known to produce beneficial effects for human health. However, the exact determinants and mechanisms leading to healthy outcomes remain to be elucidated. The purpose of this study was to investigate whether inhaling plant-emitted biogenic volatile compounds, namely monoterpenes (MTs), can produce specific effects on anxiety. Data from 505 subjects participating in 39 structured forest therapy sessions in different Italian sites, were collected. Monoterpenes air concentration was measured at each site. STAI State questionnaires were administered before and after the sessions as a measure of anxiety. A propensity score matching analysis was then performed, considering an above-average exposure to inhalable air MTs as the treatment: the estimated effect was -1.28 STAI-S points (95% C.I. -2.51 to -0.06, p = 0.04), indicating that the average effect of exposure to high MT air concentrations during forest therapy sessions is to decrease anxiety.

Food security (FS) during infancy is associated with lifelong outcomes. New Zealand is a developed economy that reports poor childhood nutrition-related health statistics, particularly among minority children, yet has no measure of FS applicable to infancy. The objective was to develop a FS index for New Zealand infants and examine its association with demographic covariates and health outcomes. Within a large (n=6853) nationally representative cohort, variables describing infant food consumption, breastfeeding, and maternal food-related coping methods were collected from mothers during late infancy. A FS index was derived using confirmatory factor analysis. Associations were assessed by logistic regressions and described using odds ratios (OR) and ≥95% confidence intervals (CI). 15% of the cohort was highly FS, 43% tenuously food insecure (FIS), and 16% highly food insecure (FIS). Infants from minority ethnic groups had lower odds of being food secure, as did those born to the youngest mothers, mothers who smoked, or lived in low-income households. FIS infants had higher odds of morbidity. Interventions to improve infant FS should focus on improving dietary quality, and give particular consideration to minority infants. We identified that FIS shows wide ethnic and socioeconomic inequity, and is associated with poorer health. The most important driving factors of FIS included poor quality weaning diets, and poverty and its proxies. Any interventions to improve infant FS should focus on increasing fruit and vegetable consumption to recommended intake levels, and give particular consideration to minority infants.

Abstract: Cardiovascular Disease (CVD) is the most prevalent disease worldwide, which has been linked to work stress because of poor job design as explained by the Job Demand-Control (JDC) and the Effort-Reward Imbalance (ERI) models. In this paper we explore for the first time relative impact of a specific aspect of organisational climate, Psychosocial Safety Climate (PSC), on any CVD including angina, myocardial infarction, hypertension, and stroke. We used two waves of interview data from Australia, with an average lag of 5 years (excluding baseline CVD, final n = 1223). Logistic regression was conducted to estimate the prospective associations between PSC at baseline on incident CVD at follow-up. It was found that participants in low PSC environments were 59% more likely to develop new CVD than those in high PSC environments. Logistic regression showed that PSC at baseline predicts lower CVD risk at follow-up (OR = 0.98, 95% CI 0.96-1.00), and this risk remained unchanged even after joint adjustment for measures of ERI and JDC. These results suggest that PSC is an independent risk factor for CVD in Australia. Beyond job design this study implicates organisational climate and prevailing management values regarding worker psychological health as the genesis of CVD.

Background: Limited data exist on postoperative acute kidney injury (AKI) in patients underwent esophageal cancer surgery. The purpose of the study was to evaluate the incidence, risk factors and consequences of postoperative acute kidney after esophagectomy. Methods: This was a retrospective cohort study. The study was conducted in a tertiary specialized cancer center in Italy. All patients undergoing elective esophageal cancer surgery between 2016 and 2021 were included in the study. AKI was defined according to Kidney Disease: Improving Global Outcomes criteria (both serum creatinine and urine output), within 48 hours after surgery. Preoperative and intraoperative data were registered. We also collected data concerning progression of AKI, need for kidney replacement therapy, mortality, medical (pulmonary, cardiovascular, septic) and surgical complications within 30 days from surgery, as well as length of hospital stay. Results: Incidence of postoperative AKI was 32%. The independent risk factors were body mass index and the invasive surgical approach. Persistent AKI accounted for 15% of the cases and it was associated with increased risk of major cardiovascular events (odds ratio 4.14, 95% CI 1.05-15.8, p-value 0.036), pulmonary complications (OR 3.67, 95% CI 1.04-14.9, p-value 0.050) and increased length of hospital stay (AME 7.2, 0.5-13.9, p-value 0.035). Conclusions: Postoperative AKI is common after esophageal cancer surgery. BMI and totally invasive surgical approach are independent risk factors. Persistent AKI lasting more than 48 hours increased the risk for cardiovascular and pulmonary complications, with prolonged length of hospital stay.

Abstract Purpose Despite a considerable amount of literature on dual-energy-CT(DECT) iodine uptake of the head and neck, the physiologic iodine uptake of this region has not been defined yet. This study aims to establish reference values for the iodine uptake of healthy organs to facilitate clinical application. Material and Methods: Consecutive venous DECT scans of head and neck were reviewed, and unremarkable exams were included (n=617). 35 region of interest measurements were performed in 16 anatomical regions. Iodine uptake was compared among different organs/tissues and subgroup analysis was performed (male [n=403] vs female [n=214]; young [n=207] vs middle-aged [n=206] vs old [n=204]; normal weight [n=314] vs overweight [n=196] vs obese [n=107]]). Results: Overall mean iodine uptake values ranged between 0.5 and 9.4mg/ml. Women showed higher iodine concentration in the cervical vessels and higher uptake for the parotid gland, masseter muscle, submandibular glands, sublingual glands, palatine tonsils, tongue body, thyroid gland, and the sternocleidomastoid muscle than men (p0.04). With increasing age, intravascular iodine concentrations increased as well as iodine uptake for cerebellum and thyroid gland, while values for tongue and palatine tonsils were lower compared to younger subjects (p0.03). Iodine concentrations for parotid glands and sternocleidomastoid muscles decreased with higher BMI (p0.004), while normal-weighted patients showed higher iodine values inside the jugular veins, other cervical glands, and tonsils versus patients with higher BMI (p0.04). Conclusion: Physiologic iodine uptake values of cervical organs and tissues show gender-, age-, and BMI-related differences, which should be considered in clinical routine of head and neck DECT.