Search Results (49)

Background/Objectives: Protein-energy wasting (PEW) affects up to 75% of hemodialysis (HD) patients, yet adherence to oral nutritional supplements (ONSs) remains poorly understood. This study evaluated ONS adherence patterns, associated socio-demographic and psychological factors, and clinical outcomes over 24 months in chronic HD patients. Methods: A 24-month prospective study was conducted in 101 HD patients. Adherence was assessed using the 4-item Morisky Medication Adherence Scale (MMAS-4), and depressive symptoms with the Beck Depression Inventory (BDI). Nutritional status was evaluated using the Malnutrition–Inflammation Score (MIS) and anthropometric measurements. Laboratory markers were obtained. Individualized nutritional education was provided at each visit. Results: Regular ONS use was reported in 50.5% of patients. High adherence (MMAS-4 = 0) was observed in 36.6% of the cohort. Forgetfulness (45.3%) and adverse effects (34.4%) were the most common obstacles. Adherence was significantly associated with sex (p = 0.007), with men more frequently demonstrating low adherence. Education level showed a weak, but significant positive correlation with MMAS-4 score (Spearman’s ρ = 0.25, p = 0.018), indicating slightly lower adherence among more educated patients. MMAS-4 and BDI scores were positively correlated (Spearman’s ρ = 0.25, p = 0.04), indicating that greater depressive symptom burden was associated with lower adherence. Regular ONS users demonstrated improved nutritional status (lower MIS; 9 vs. 7, p < 0.001), higher hemoglobin (106 vs. 114 g/L, p = 0.03), and increased mid-upper arm circumference (MUAC; 26 vs. 28 cm, p = 0.02). Lean tissue mass was preserved over time (p = 0.009). However, individualized education had limited effect on patients with initially low adherence. Individualized nutritional education was associated with improved acceptance and implementation of recommendations. Over two years of follow-up, nutritional education was associated with preserved lean and fat tissue index (LTI, p = 0.009; FTI, p = 0.08), reductions in interdialytic weight gain, and significant improvements in MUAC, waist circumference, and scapular skinfold thickness (p = 0.03; p < 0.001; p = 0.02). Prealbumin and hemoglobin levels also increased significantly (p = 0.02; p = 0.04). However, education alone was insufficient for certain subgroups, particularly older patients and those initially classified as non-adherent. During follow-up, 17 patients died. Lower MUAC (OR = 2.97, 95% CI: 1.45–6.08) and triceps skinfold thickness (OR = 1.37, 95% CI: 1.12–1.68) were the strongest independent predictors of mortality. Conclusions: Adherence to ONSs remains suboptimal in HD patients. Individualized nutritional education was associated with improved adherence and nutritional status in some subgroups but may be insufficient in older or initially non-adherent patients. Simple anthropometric markers are strong mortality predictors and may offer practical value for routine monitoring. Full article

Hypertrophic cardiomyopathy (HCM) is a relatively common global cardiac disease, usually inherited, with complex phenotypes, genetic features, and a natural history. In this study, we constructed atic^−/− zebrafish using the CRISPR/Cas9 gene-editing system and found that atic^−/− zebrafish hearts exhibited HCM symptoms, and atic^−/− zebrafish hearts showed progressive enlargement, eccentric hypertrophy, cardiomyocyte enlargement, and collagen fiber deposition. Echocardiography results also showed that compared with atic^−/− zebrafish hearts, in wild-type zebrafish hearts, the ejection fraction was significantly reduced, shortening fraction was reduced, and ventricular wall thickness was significantly increased. Meanwhile, aerobic exercise intervention in atic^−/− zebrafish showed that aerobic exercise effectively improved the symptoms of HCM and improved cardiac function in atic^−/− zebrafish hearts. Transcriptome sequencing results showed that aerobic exercise improved the symptoms of HCM in atic^−/− zebrafish hearts involving the calcium signaling pathway, Apelin signaling pathway and ECM–receptor interaction. The q-PCR results of key differential genes involved in these pathways further confirmed that aerobic exercise could bring beneficial effects to atic^−/− zebrafish. In conclusion, this study found that the loss of ATIC can lead to hypertrophic cardiomyopathy in zebrafish, and aerobic exercise intervention can effectively improve the hypertrophic pathological characteristics of atic^−/− zebrafish hearts, providing new intervention targets and effective lifestyle interventions for HCM. Full article

The Republic of Turkey established its first match factory in Sinop in 1929 but had to relocate it even before it was in operation due to severe structural damage caused by ground settlement. In July 1930, through his US-based firm the American–Turkish Investment Corporation (ATIC), the Swedish “Match King” Ivar Kreuger signed a contract with the Republic of Turkey to build and operate a factory in Büyükdere, Istanbul. By 1930, Kreuger had already established a match production monopoly in nearly every country in Europe and that year created a similar financial system for Turkey, gaining control of match production for 25 years. This article explains the events surrounding the establishment of his modern production facility in Turkey, with a particular focus on its engineering aspects. It details the strategically chosen location, the engineering solutions for the factory’s construction, its production lines, and what the country gained and lost from it. In order to determine the establishment and production processes of the facility, the authors examined domestic and foreign archival documents, firsthand news reports from the period, articles and theses, and all other available documents. After the contract was terminated by both parties, the Turkish government and ATIC, in May 1943, the factory continued its production and storage activities until May 1989. At that point, the factory and all its equipment were integrated into another existing facility in the İnegöl district of Bursa province. Almost all the buildings of the Büyükdere Match Factory were demolished, and the land was repurposed for a 450-bed regional hospital in 2012. In short, this article deploys the Büyükdere Match Factory as a case study to examine what Turkey gained and lost from the establishment and production processes of a modern industrial factory, enabled by US–Turkish collaboration, and equipped with the most advanced manufacturing and engineering technologies of the time. Full article

Patients hospitalized due to coronavirus disease 2019 (COVID-19) usually present with severe or critical intensity of symptoms, accompanied by a marked systemic inflammatory response. Classical inflammatory biomarkers, C-reactive protein (CRP), albumin, and red blood cell distribution width (RDW) have previously been reported to be prognostic in hospitalized COVID-19 patients. We performed a retrospective analysis of two large cohorts (2305 and 2328 patients, respectively) of consecutive hospitalized COVID-19 patients with mostly severe and critical symptoms admitted to the tertiary referral center to develop and validate a prognostic score for 30-day mortality based on CRP-to-Albumin-Ratio (CAR), RDW, and age (termed CARRA-VID score). We identified 6 prognostic categories: very low, low, intermediate-1, intermediate-2, high, and very high risk, with corresponding 30-day mortality rates of 2.7%, 10.7%, 30.9%, 47.1%, 61.9%, and 89.7%, respectively. Effective risk stratification was validated in an independent cohort of patients and remained independent of the World Health Organization-defined disease severity and other commonly utilized risk scores. Additional analyses evaluated the score across different time periods dominated by distinct viral variants. We also present a simplified 3-tiered version of the score. A Microsoft Excel Workbook containing the score calculator is provided. Full article

Methotrexate (MTX) is the conventional synthetic disease-modifying anti-rheumatic drug (csDMARD) recommended as the first-choice anti-rheumatic drug for rheumatoid arthritis (RA). However, responses to MTX may be influenced by genetic variants. We aim to evaluate the association of the rs2372536, rs4673990, and rs4673993 genetic variants of the ATIC gene with therapeutic failure of MTX in patients with RA. A case–control study was performed. Disease activity was measured using the disease activity score based on erythrocyte sedimentation rate (DAS28-ESR). RA patients were classified into two groups: (a) responders (DAS28-ESR ≤ 3.2), which is the group of patients who did respond to methotrexate, and (b) non-responders (DAS28-ESR > 3.2), which is the group of patients who did not respond to methotrexate. Serum levels of the 5-aminoimidazole-4-carboxamide ribonucleotide (AICAR) enzyme and Interleukin-6 (IL-6) were quantified using an enzyme-linked immunosorbent assay (ELISA). Genotyping of ATIC genetic variants was performed with quantitative polymerase chain reaction (qPCR) using TaqMan probes. A total of 260 patients with RA were included. In total, 142 (54.6%) were non-responders to MTX. IL-6 levels were increased in the non-responder group (p = 0.002), while no statistical differences were observed in the AICAR levels. The variables associated with non-response were higher HAQ-Di, weekly MTX dose, glucocorticoid use, erythrocyte sedimentation rate, and carriers of the polymorphic homozygous variant of rs4673993 (OR = 4.5, 95% CI: 1.04–19.34; p = 0.04). The use of sulfazaline offered protective effects. Our findings indicate that the polymorphism rs4673993 gene variant of the AICAR protein may significantly influence MTX resistance. Therefore, these results support the importance of the pathway generating extracellular adenosine and its effects on promoting the immune regulation for the mechanism of MTX therapy of RA. Full article

Soil moisture is a core climate variable in land surface processes and has a strong influence on the energy balance and water exchange between the land surface–vegetation–atmosphere columns. However, the low spatial resolution of soil moisture remote sensing products cannot satisfy the requirements of research and applications based on hydro-meteorological and eco-hydrological simulations and the management of water resources at the watershed scale. A feasible solution is to downscale soil moisture products derived from microwave remote sensing, which often requires the support of auxiliary variables. Meanwhile, during the validation process of remote sensing products, the spatial scales between in situ observations and remote sensing pixel retrievals are inconsistent; thus, in situ observations should be translated to ground truths at a pixel scale via reasonable upscaling methods. Many auxiliary variables can serve as proxies in the scaling of soil moisture, although few studies have analyzed their feasibility and application conditions. In this paper, a SiB2 (Simple Biosphere Model-II) simulation for the Daman superstation from 1 May to 30 September 2013, was employed to calculate seven auxiliary variables related to soil moisture: ATIs and ATIc (Apparent Thermal Inertias based on surface soil temperature and canopy temperature), E (Evaporation), E/ET_a (Ratio of Evaporation and Actual Evapotranspiration), E/ET_p (Ratio of Evaporation and Potential Evapotranspiration), EF (Evaporative Fraction) and AEF (Actual Evaporative Fraction). The applicability of these variables was then evaluated via a correlation analysis between the variables and soil moisture. The results indicated that E is highly sensitive to soil moisture at Phase I (R² ≥ 0.67), whereas ATIs is the greatest indicator of soil moisture at Phase II (R² ≥ 0.51). Considering both the correlation and computability of these auxiliary variables, the EF (R² ≥ 0.56) and AEF (R² ≥ 0.54) are recommended as proxies for Phase I, while ATIs (R² ≥ 0.51) is also recommended for Phase II. Full article

Background/Objectives: Fabry disease (FD) is a genetic lysosomal storage disease caused by a pathogenic variant in GLA gene coding for a functional alpha-galactosidase A enzyme whose disfunction leads to globotriaosylceramide (Gb3) accumulation in cells, which results in multiple organ disorders. The aim of this study was to identify mutations associated with Fabry disease among 829 kidney transplant recipients and to investigate the correlation between the factors such as age, dialysis vintage, eGFR, proteinuria and corticosteroid dose and the deviations in alpha-galactosidase A and lyso-Gb3 levels. Methods: Dry blood spot samples were collected for genetic analysis. The GLA genetic variants were analysed by an amplicon-based next-generation sequencing approach in all female patients and in male patients with reduced alpha-galactosidase A levels. Alpha-galactosidase A and Lyso-Gb3 were not determined in female patients. Pearson’s correlation coefficient was used to assess the relationship between the above-mentioned factors with the activity of alpha-galactosidase A and Lyso-Gb3. Results: Genetic testing was performed in 476 patients, all female patients (334), 69 male patients with decreased level of alpha-galactosidase A activity, one male patient with alpha-galactosidase A levels above the quantification limit and 72 male patients with no interpretable results of alpha-galactosidase A activity due to preanalytical error. In 3 (0.4%) male patients, hemizygous mutations associated with Fabry disease were found, and those were c.427G&gt;A p.(Ala143Thr), c.1181T&gt;C p.(Leu394Pro), and c.352C&gt;T p.(Arg118Cys). The dose of corticosteroid therapy seemed to be positively correlated to alpha-galactosidase A activity and negatively to Lyso-Gb3 levels in blood. Conclusions: Genetic testing of individuals with chronic kidney disease and reporting of genetic variants associated with the Fabry phenotype are important to improve the overall knowledge of the disease. Further research is needed to define factors influencing levels of alpha-galactosidase A and Lyso-Gb3. Full article

Sphingolipids (SLs) are bioactive signaling molecules essential for various cellular processes, including cell survival, proliferation, migration, and apoptosis. Key SLs such as ceramides, sphingosine, and their phosphorylated forms play critical roles in cellular integrity. Dysregulation of SL levels is implicated in numerous diseases, notably chronic kidney disease (CKD). This review focuses on the role of SLs in CKD, highlighting their potential as biomarkers for early detection and prognosis. SLs maintain renal function by modulating the glomerular filtration barrier, primarily through the activity of podocytes. An imbalance in SLs can lead to podocyte damage, contributing to CKD progression. SL metabolism involves complex enzyme-catalyzed pathways, with ceramide serving as a central molecule in de novo and salvage pathways. Ceramides induce apoptosis and are implicated in oxidative stress and inflammation, while sphingosine-1-phosphate (S1P) promotes cell survival and vascular health. Studies have shown that SL metabolism disorders are linked to CKD progression, diabetic kidney disease, and glomerular diseases. Targeting SL pathways could offer novel therapeutic approaches for CKD. This review synthesizes recent research on SL signaling regulation in kidney diseases, emphasizing the importance of maintaining SL balance for renal health and the potential therapeutic benefits of modulating SL pathways. Full article

Background: Kidney transplantation is considered the best modality for renal replacement therapy. The use of immunosuppressive therapy and pre-existing and newly developed comorbidities predispose these patients to the use of a large number of medications. (Hyper)polypharmacy is associated with worse adherence and negative outcomes. This study aims to explore the factors correlated with hyperpolypharmacy and complex medication regimens in kidney transplant recipients. Methods: This is a cross-sectional study of outpatient kidney transplant recipients. Collected data include demographic data, complete chronic medication lists, medical history, and graft function. Linear and logistic regression were used to identify factors associated with hyperpolypharmacy and complex medication regimens. Medication regimen complexity was quantified by the Medication Regimen Complexity Index (MRCI). Results: Overall, 224 kidney transplant recipients were included, with an average time since transplantation of 8 years. Hyperpolypharmacy was present in more than two-thirds of patients; the average number of different medications was 12; and the mean MRCI score was 21.4, ranging from 6 to 50. Hypertension was almost universally present, while other frequently prescribed medication groups were hypolipemics, medication for bone-mineral metabolism disorders, gout, and antihyperglycemics. Conclusions: Factors independently associated with hyperpolypharmacy and complex medication regimens were found to be age and graft function. Studies investigating interventions aimed at reducing medication complexity and increasing adherence should focus on older patients with worse graft function. Full article

Estimation of the power obtained from intermittent renewable energy sources (IRESs) is an important issue for the integration of these power plants into the power system. In this study, the expected power not served (EPNS) formula, a reliability criterion for power systems, is developed with a new method that takes into consideration the power generated from IRESs and the consumed power (CP) estimation errors. In the proposed method, CP, generated wind power (GWP), and generated solar power (GSP) predictions made with machine learning methods are included in the EPNS formulation. The most accurate prediction results were obtained with the Multi Layer Perceptron (MLP), Long-Short Term Memory (LSTM), and Convolutional Neural Network (CNN) algorithms used for prediction, and these results were compared. Using different forecasting methods, the relation between forecast accuracy, reserve requirement, and total cost was examined. Reliability, smart reserve planning (SRP), and total cost analysis for power systems were carried out with the CNN algorithm, which provides the most successful prediction result among the prediction algorithms used. The effect of increasing the limit EPNS value allowed by the power system operator, that is, reducing the system reliability, on the reserve requirement and total cost has been revealed. This study provides a useful proposal for the integration of IRESs, such as solar and wind power plants, into power systems. Full article

Background: The aim of this multicentre retrospective study is to determine the incidence, etiology, clinical characteristics, and outcomes of kidney transplant recipients diagnosed and treated for acute pancreatitis. Methods: We analyzed data from kidney transplant recipients who received kidney allografts between October 1973 and December 2023 and were diagnosed and treated for acute pancreatitis. Results: Of 2482 patients who received kidney allografts, 10 (0.4%) (5 male) were diagnosed with acute pancreatitis, with a mean age of 48.6 years. Patients were diagnosed with acute pancreatitis between 3 weeks and 24 years after the transplantation. Possible etiologies included cholecystolithiasis, COVID-19, hypercalcemia, postprocedural, use of cannabis, trimetoprim-sulphometoxasole, statins, sirolimus, tacrolimus and obesity. There was no suspected etiology in two patients. Patients were treated with aggressive hydration, pain alleviation and antibiotics if indicated. Four patients developed complications. Local complications included peripancreatic collections, pseudocyst, and abscesses formation, while systemic complications occurred in the form of Cytomegalovirus (CMV) reactivation and urinary tract infection. All patients survived with preserved kidney allograft function. Conclusions: Acute pancreatitis in kidney transplant recipients is rare. However, it may be linked to significant morbidity and mortality. While symptoms may be nonspecific and brought on by a variety of viral and non-infectious illnesses, as well as adverse effects from immunosuppressive medications, a high degree of awareness is required. Full article

ZnO-based heterostructures are up-and-coming candidates for terahertz (THz) optoelectronic devices, largely owing to their innate material attributes. The significant ZnO LO-phonon energy plays a pivotal role in mitigating thermally induced LO-phonon scattering, potentially significantly elevating the temperature performance of quantum cascade lasers (QCLs). In this work, we calculate the electronic structure and absorption of ZnO/ZnMgO multiple semiconductor quantum wells (MQWs) and the current density–voltage characteristics of nonpolar m-plane ZnO/ZnMgO double-barrier resonant tunnelling diodes (RTDs). Both MQWs and RTDs are considered here as two building blocks of a QCL. We show how the doping, Mg percentage and layer thickness affect the absorption of MQWs at room temperature. We confirm that in the high doping concentrations regime, a full quantum treatment that includes the depolarisation shift effect must be considered, as it shifts mid-infrared absorption peak energy for several tens of meV. Furthermore, we also focus on the performance of RTDs for various parameter changes and conclude that, to maximise the peak-to-valley ratio (PVR), the optimal doping density of the analysed ZnO/Zn₈₈Mg₁₂O double-barrier RTD should be approximately ${10}^{18}{\mathrm{c}\mathrm{m}}^{-3}$, whilst the optimal barrier thickness should be 1.3 nm, with a Mg mole fraction of ~9%. Full article

Background: Cognitive remediation therapy (CRT) for anorexia nervosa (AN) is an intervention specifically focused on addressing cognitive difficulties associated with the eating disorder. This systematic review of systematic reviews and meta-analysis aimed to provide a summary of the existing literature examining the efficacy of CRT in improving the neuropsychological, psychological, and clinical parameters of patients with AN. Methods: Systematic reviews and meta-analyses were sought in electronic databases, encompassing studies that explored the impact of CRT on AN. Three eligible reviews were identified based on the inclusion criteria. The Revised Assessment of Multiple SysTemAtic Reviews (R-AMSTAR) was employed to evaluate the methodological quality of the reviews, and all included reviews demonstrated satisfactory methodological quality with an R-AMSTAR score of ≥22. Relevant information was extracted from each review and qualitatively compiled. Results: Findings suggest that CRT can help people increase their awareness of cognitive styles and information processing and have a positive effect on patients’ responses to treatment. Conclusions: Further research is required to better understand its impact on other relevant outcomes, including psychological variables, to optimize the treatment’s benefits. Full article

This manuscript describes an implementation of scripts of code aimed at reducing the influence of artifacts, specifically focused on ocular artifacts, in the measurement and processing of electroencephalogram (EEG) signals. This process is of importance because it benefits the analysis and study of long trial samples when the appearance of ocular artifacts cannot be avoided by simply discarding trials. The implementations provided to the reader illustrate, with slight modifications, previously proposed methods aimed at the partial or complete elimination of EEG channels or components obtained after independent component analysis (ICA) of EEG signals. These channels or components are those that resemble the electro-oculogram (EOG) signals in which artifacts are detected. In addition to the description of each of the provided functions, examples of utilization and illustrative figures will be included to show the expected results and processing pipeline. Full article

The MiniMovers (MM) APP combines motor development theory with creativity expertise and has been designed to provide parents with developmentally appropriate activities to support children’s motor skills. This study investigates how MiniMovers activities enabled parents to support their children’s physical development. Families participated in an 8-week MM programme of activities from the MM APP (Mini, Mighty and Mega levels), with pre- and post-intervention data collected using multiple tools (e.g., motion capture system, force plate, eye-tracking glasses, and videos). Mixed research methods were applied among children (N = 8; aged 21–79 months) and their parents, providing quantitative analysis on children’s performance (running, throwing, jumping, kicking, balancing and catching), as well as qualitative analysis on parents’ attitude and behaviour (two-weekly feedback surveys and interviews). Lab-based measures showed significant improvements in run time, underarm throwing distance, and horizontal jump distance. Test of Gross Motor Development-3 showed a significant gain in running, underarm and overarm throwing, horizontal jump and kicking. Further, developmental stages indicated significant improvements in running, kicking and catching. Parents reported increased enjoyment and knowledge, children’s enjoyment, independence and confidence. This pilot study provides support for the research and development of the MM App and suggests more research into the use of APPs to support home activities among families with young children. Full article