Coronavirus Disease 2019 (COVID-19) and other lower respiratory tract diseases (LRTDs), including bacterial pneumonia and acute respiratory distress syndrome, share overlapping clinical features but arise from distinct pathophysiological mechanisms. The molecular signatures that distinguish these diseases remain insufficiently characterized in African populations, where genetic background, endemic infections, and environmental exposures may substantially shape immune responses. We integrated spatially resolved single-cell transcriptomic profiles from lung autopsy specimens of 30 Malawian patients, including 10 with COVID-19, 12 with other LRTDs, and 8 non-LRTD controls. In total, 61,391 cells representing 15 cell types and 36,602 gene expression features were analyzed. Using an integrated machine learning framework that combined nine feature-ranking algorithms with incremental feature selection, we identified potential molecular signatures that could discriminate among disease states within this cohort. The optimal classification models achieved weighted F1 scores greater than 0.94, demonstrating a robust capacity to differentiate COVID-19 from other LRTDs in our dataset. Notably, the macrophage-associated state in COVID-19 was dominated by an IFN-γ response with upregulation of CD163 and HLA-DQA2, contrasting sharply with the type I/III interferon signature reported in European cohorts. In addition, we observed cell-type-specific COVID-19 signatures, including downregulation of CAV1 in AT1 cells, consistent with epithelial damage; dysregulation of SFTPC in AT2 cells, suggesting surfactant dysfunction; and upregulation of NFKBIA in neutrophils, indicating altered inflammatory regulation. Gene Ontology enrichment further revealed universal disruption of protein synthesis machinery, along with cell-type-specific alterations in immune activation, epithelial repair, and inflammatory signaling pathways.

Nasopharyngeal carcinoma (NPC) presents unique clinical and biological characteristics that distinguish it from other head and neck malignancies. It poses a great therapeutic challenge for many specialists. It is associated with Epstein–Barr virus (EBV) infection, genetic predisposition, and environmental risk factors. With advancements in radiotherapy and systemic therapy, new treatment options have emerged. We want to focus on contemporary therapeutic strategies for NPC, emphasizing breakthroughs in intensity-modulated radiotherapy (IMRT), chemoradiotherapy, targeted therapy, immunotherapy, and emerging cellular therapies. By integrating recent discoveries with clinical evidence, we aim to provide state-of-the-art information, along with a comprehensive understanding of current best practices, emerging treatments, and critical prognostic determinants in NPC.

Background: Therapeutic drug monitoring (TDM) of anti-TNF biologics may help optimise treatment in rheumatoid arthritis (RA), but current therapeutic ranges do not always reflect clinical response in routine practice. Methods: We conducted a retrospective observational study including 224 adults with RA treated with infliximab (IFX), adalimumab (ADL), or etanercept (ETN) during the maintenance phase at Hospital Universitario Puerto Real between May 2016 and May 2023. Drug and anti-drug antibody levels were measured by sandwich ELISA and analysed against clinical response using DAS28. Demographic and clinical variables, associations between drug levels and response, the effect of antibodies, correlations between serum concentrations and DAS28, and the performance of current and proposed therapeutic ranges were evaluated. Results: The cohort was mainly female (62.1%), with a mean age of 57.7 years, BMI of 28.5 kg/m2, and mean DAS28 of 3.33. ETN was most frequently used (62.5%), followed by ADL (21.9%) and IFX (15.6%). Drug levels were significantly associated with response (p < 0.001). Anti-drug antibodies were strongly linked to non-response, especially with IFX and ADL. Serum drug levels correlated inversely with disease activity for IFX and ADL, but not for ETN. Current therapeutic ranges showed low sensitivity, while lower proposed ranges improved sensitivity considerably. Conclusions: Current anti-TNF therapeutic ranges have limited ability to identify responders in real-world RA. Lowering the lower bound improves sensitivity and supports more individualised TDM, particularly for IFX and ADL, pending prospective validation.

Background/Objectives: An incorrect intradeltoid injection technique can cause shoulder injury related to vaccine administration, including bursitis, septic arthritis, and axillary nerve injury, particularly when Western-derived landmarks and needle-length tables are applied to smaller-framed Southeast Asian adults. We aimed to define an individualized deltoid injection landmark and needle length that avoid the axillary nerve while ensuring reliable intramuscular delivery in Southeast Asian adults. Methods: In this cross-sectional ultrasound study of adults aged ≥18 years, four vertical landmarks below the acromion (individual contralateral 2-fingerbreadth (FB), individual contralateral 3-FB, average 2-FB, average 3-FB) were assessed in two arm positions (adduction and approximately 30° abduction with the hand on the waist). For each combination, we recorded the presence of the axillary nerve and measured skin-to-subcutaneous and deltoid muscle thickness to estimate whether 0.5-, 1-, or 1.5-inch needles would terminate within muscle or penetrate the subdeltoid bursa. Results: Eighty-two participants (39 males, 43 females) were included. The axillary nerve was not visualized at the individualized contralateral 2-FB landmark in adduction but was present at 31.7–50.0% of other landmark–position combinations. At the individualized 2-FB site in adduction, mean skin-to-subcutaneous thickness was <12.7 mm and mean skin-to-subdeltoid fascia distance exceeded 12.7 mm in all strata, implying that a 0.5-inch needle would consistently terminate within the deltoid muscle. Conclusions: In Southeast Asian adults, the contralateral individualized 2-FB landmark in arm adduction provides a neurovascularly safe window for intradeltoid vaccination, and a 0.5-inch needle offers reliable intramuscular delivery while minimizing the risk of bursal penetration.

This study systematically investigated the influence of approach kinematics on the subsequent kinetics and power production strategies during the approach to running jumps with a single leg (ARJSL). Twenty-five physically active male university students performed ARJSL trials under two prescribed approach speeds (fast and slow) and three approach distances (3, 6, and 9 m) in a 2 × 3 within-subjects design. Three-dimensional motion capture synchronized with force platform data was used to quantify jump height (JH), vertical touchdown velocity (TDv), reactive strength index (RSI), peak joint power (hip, knee, and ankle), and joint stiffness. Significant approach speed × distance interactions were observed for JH (p = 0.006), TDv (p < 0.001), RSI (p = 0.014), ankle stiffness (p = 0.006), and peak power generation at all lower-limb joints (all p < 0.034). The results demonstrate that changes in approach strategy systematically alter the distribution of mechanical power among the hip, knee, and ankle joints, thereby influencing the effectiveness of horizontal-to-vertical momentum conversion during take-off. Notably, RSI and ankle stiffness were particularly sensitive to combined manipulations of speed and distance, highlighting their value as neuromechanical indicators of stretch–shortening cycle intensity and joint loading demands. In conclusion, ARJSL performance depends on finely tuned, speed- and distance-specific biomechanical adaptations within the lower extremity. These findings provide a constrained, joint-level mechanical characterization of how approach speed and distance interact to influence power redistribution and stiffness behavior during ARJSL, without implying optimal or performance-maximizing strategies.

Lipodystrophy is a rare group of metabolic disorders characterized by the abnormal distribution of body fat, which can lead to various metabolic complications due to the body’s inability to adequately process carbohydrates and fat. We report the case of a female, aged 53 years, who was admitted as an outpatient for progressive weight loss of the upper part of the body (face, neck, arms, and chest), dyspeptic complaints, fatigue, mild insomnia, and anxious behavior. Her medical history was characterized by the presence of dyslipidemia, hypertension, and a minor stroke episode. However, she denied any family-relevant medical history. Although the clinical perspective suggested a possible late onset of partial acquired lipodystrophy, due to the imaging exam that revealed an enlarged liver with inhomogeneous structure with multiple nodular lesions, scattered over both lobes, a lot of lab work-ups and complementary studies were performed. Eventually, a liver biopsy was performed by a laparoscopic approach during cholecystectomy, the histology consistent with metabolic disease-associated steatohepatitis (MASH). In conclusion, given their heterogeneity and rarity, lipodystrophies may be either overlooked or misdiagnosed for other entities. Barraquer–Simons syndrome (BSS) may be associated with liver disease, including cirrhosis and liver failure. Liver lipodystrophy in BSS may sometimes feature steatosis with a focal, multi-nodular aspect, multiplying the diagnostic burden. Liver lipodystrophy may manifest as asymptomatic fat accumulation but may progress to severe conditions, representing one of the major causes of mortality in BSS, apart from the cardio-vascular comorbidities. Given the potential of severe outcomes, it is mandatory to correctly assess the stage of liver disease since the first diagnosis.

Background/Objectives: It is well established in the modern literature that newborns delivered from multiple gestations are more predisposed to low birthweight in comparison to their singleton equivalents. In this study, we sought to explore the potential of first-trimester biochemical (PAPP-A and free β-hCG) and biophysical indices (uterine artery Doppler) to predict low birthweight in one or both twins. Methods: This is a retrospective cohort analysis of 400 twin viable pregnancies presenting for routine first-trimester assessment in four fetal medicine centers between 2014 and 2025. The examination included the recording of maternal demographic characteristics and medical history, the assessment of markers of aneuploidy and the fetal anatomy, the measurement of mean arterial pressure, the assessment of uterine arteries and the measurement of serum concentration of PAPP-A and free β-hCG. The evaluated outcomes included BW ≤ 3rd centile and BW ≤ 10th centile in one or both twins based on local population birthweight reference charts. Results: The study cohort consisted of 400 twin pregnancies. BW ≤ 3rd centile in one or both twins was reported in 1.5 and 3.8% of cases, respectively, and there was no association of BW ≤ 3rd centile with any of the studied parameters. BW ≤ 10th centile in one or both twins was reported in 14.8 and 9.8% of the cases, respectively. PAPP-A MoM values were significantly lower in cases complicated by BW ≤ 10th centile in one and in both twins, remaining statistically significant even after the appropriate multiple logistic regression. PAPP-A MoM demonstrated statistically significant but low prognostic value for BW ≤ 10th centile in either one or both twins. Conclusions: Low PAPP-A levels were associated with BW ≤ 10th centile in one and both twins and its significant value as a risk marker was demonstrated. Higher PAPP-A MoM halves the risk of having at least one twin with low BW. Other maternal biophysical and biochemical indices did not seem to be predictive of low birthweight.

Primary hypoadrenocorticism (Addison’s disease) is an uncommon but potentially life-threatening endocrine disorder in dogs. Affected animals may present with clinicopathological features mimicking acute kidney injury (AKI). The challenge in diagnosing hypoadrenocorticism arises from its highly heterogeneous and non-specific clinical presentation, including acute kidney injury (AKI). This retrospective observational study aimed to evaluate dogs presenting with AKI and to identify cases in which primary hypoadrenocorticism was the underlying etiology. Thirty-four dogs diagnosed with acute kidney injury were evaluated at the Clinical Hospital for Companion Animals of the “Ion Ionescu de la Brad” University of Life Sciences, Iași, Romania, among which three (8.8%) were endocrinologically confirmed to have primary hypoadrenocorticism. The evaluation protocol included a complete clinical examination, hematological, biochemical, and hormonal investigations, urinalysis, abdominal ultrasonography, and an ACTH stimulation test. These dogs exhibited hyponatremia, hyperkalemia, a reduced sodium-to-potassium ratio, and azotemia at admission, closely resembling intrinsic AKI. Following fluid therapy and hormone replacement, rapid normalization of electrolyte and renal parameters was observed. These findings support hypovolemia and electrolyte imbalance as the primary mechanisms underlying reversible prerenal azotemia in these cases. If not diagnosed early, this condition has a significant risk of progressing to acute tubular necrosis. The findings highlight the need for careful differentiation between primary AKI and renal dysfunction secondary to Addison’s disease, as well as the importance of promptly initiating hormone replacement therapy. In conclusion, hypoadrenocorticism should be considered in dogs presenting with AKI and electrolyte imbalance. Early endocrine evaluation and prompt initiation of targeted therapy are essential to avoiding misdiagnosis and optimizing clinical outcomes.

Background: This study aimed to comprehensively define the clinical profile of elderly patients with hereditary angioedema (HAE) caused by C1 esterase inhibitor (C1INH) deficiency and/or dysfunction (HAE-C1INH). Furthermore, it sought to reveal age-related differences in disease expression and management by comparing these patients with their younger counterparts. Methods: In this retrospective study, seventy-six patients were included. All patients had been diagnosed with HAE-C1INH. Results: A total of 9 (12%) patients were ≥65 years, 7 (77%) of whom were female. The median age at the time of diagnosis was higher in the elderly group, whereas the median age at the first symptom was similar. There was a significant delay in diagnosis time in the elderly group. Hypertension was the most frequent comorbidity among elderly patients. The median number of angioedema attacks in the last year was 6, and similar to 10 in patients < 65 years. Angioedema control in the last three months was lower in older patients. The rate of laryngeal edema was similar in patients < 65 years and older patients. The use of short-term prophylaxis (STP) was higher in the elderly group. The most commonly used treatment for acute attacks was pdC1-INH. Two patients in the elderly group did not benefit from danazol. No adverse events with icatibant, pdC1-INH, danazol were encountered among patients. Conclusions: Compared to patients younger than 65 years of age, annual attack rates were similar, whereas elderly patients had lower angioedema control for the last three months. The use of STP rates was higher among elderly patients.

The present study aimed to investigate the effect of Turnera diffusa supplementation on the quantitative and qualitative characteristics of semen in Duroc boars (n = 4). The experiment was divided into two periods, each corresponding to the duration of one spermatogenic cycle: a control period (40 days) (CP) and an experimental period (40 days) (EP). Nutrition and environmental conditions were kept constant throughout both periods. During the experimental period, each boar received a daily supplement of 7 g of Turnera diffusa extract. In each period, five ejaculates were collected from each boar included in the study. The ejaculates were evaluated for volume, sperm concentration, motility, agglutination, number of insemination doses obtained per ejaculate after dilution, and sperm viability after 24, 48, and 72 h of storage. The results of a two-way repeated measures ANOVA showed that the combined effect of boar × treatment significantly influenced ejaculate volume (p < 0.01) and viability after 48 h of storage (p < 0.05). The results of the two-way repeated measures ANOVA showed that treatment with the tested additive T. diffusa significantly affected sperm survival during storage for 24 h (p < 0.01), 48 h (p < 0.001), and 72 h (p < 0.05). Bonferroni post hoc analysis indicated that T. diffusa significantly affected only the parameters related to sperm viability, namely survival rates at 24 h (p < 0.001), 48 h (p < 0.01), and 72 h (p < 0.01). The findings of this study demonstrate that the application of the tested supplement, at the specified dose and duration, has a positive effect on semen quality in boars.