Search Results (48,656)

Heart failure with reduced ejection fraction (HFrEF) is increasingly recognized as a systemic metabolic disorder. The aim of this study was to characterize amino acid-related metabolic differences between heart failure with moderately reduced ejection fraction (HFmrEF) (LVEF 40–49%) and HFrEF (LVEF < 40%) and to derive a biologically interpretable composite metabolomic index capable of discriminating between these two stages of systolic dysfunction. We conducted a cross-sectional metabolomic analysis of 42 patients stratified by left ventricular ejection fraction (LVEF < 40% vs. 40–49%). The reference group comprised patients with mildly reduced ejection fraction (LVEF 40–49%), without inclusion of individuals with preserved or normal cardiac function. Targeted amino acid profiling was performed using liquid chromatography-tandem mass spectrometry (LC–MS/MS). Metabolites were standardized and analyzed individually and in combination. A composite index (Heart Failure Amino Acid-Derived Systolic Index: HASI-40), integrating markers of proteolysis and metabolic resilience, was derived to distinguish patients with HFrEF from those with HFmrEF. Discrimination was assessed using receiver operator curve (ROC) analysis with internal validation and multivariable adjustment. Patients with LVEF < 40% exhibited a coordinated metabolic phenotype characterized by reduced methionine, sarcosine, serine, and taurine. While individual metabolites did not retain significance after multiple-testing correction, the composite HASI-40 index remained strongly associated with HFrEF (OR 5.56, 95% CI: 1.70–18.14; p = 0.004), although the wide confidence interval indicates limited precision due to sample size. The index demonstrated good discrimination with an area under the curve (AUC) of 0.862, which improved when combined with age (AUC 0.932). The index represents a standardized composite measure and does not define a diagnostic cutoff for individual patients. These findings suggest that HFmrEF and HFrEF exhibit partially distinct metabolic phenotypes despite overlapping clinical characteristics. These findings suggest that HASI-40 captures metabolic differences between patients with HFmrEF (LVEF 40–49%) and those with HFrEF (LVEF < 40%), reflecting progression toward more advanced systolic dysfunction. However, due to the absence of a control group with preserved ejection fraction, small sample size, and lack of external validation, the index should be considered exploratory and hypothesis-generating rather than clinically applicable. Full article

Background: The nursing profession is recognized as a high-risk occupation, with the emotional toll on healthcare workers reaching a critical point. A complex interplay of anger and cynicism, often stemming from systemic pressures and chronic moral injury, seems to increasingly affect nurses’ professional and personal lives. This psychological strain does not end when the shift ends; rather, it often manifests as insomnia and nightmare distress, creating a vicious cycle of exhaustion and emotional instability. This article explores how anger, cynical distrust, nightmare distress and insomnia are interrelated and jeopardize the well-being of nursing staff and what these “invisible” symptoms reveal about the current state of healthcare by confirming their prevalence rates. Methods: This cross-sectional study was conducted online in October 2025 and included 441 hospital nurses who completed the Dimensions of Anger Reactions-5 (DAR-5), the 8-item Cynical Distrust scale (CDS-8), the Nightmare Distress Questionnaire (NDQ) and the Athens Insomnia Scale (AIS). Results: The prevalence rates of anger, nightmare distress and insomnia were 41.5%, 6.6%, and 62.1%, respectively. Based on the CDS-8 scores, a notable proportion (20.9%) of nurses fell within the highest quartile of CDS-8 scores (CDS-8 > 29), indicating relatively elevated cynical distrust within this sample; this threshold is sample-derived and does not correspond to a validated clinical cut-off. Hierarchical multiple regression analysis indicated that the DAR-5 explained 22.1% of the variance in AIS, while an additional 10.2% was explained by NDQ and another 1.5% by the CDS-8. Both cynical distrust and nightmare distress displayed a chain mediation pattern in the association between anger and insomnia; however, given the cross-sectional design, the temporal order of these variables cannot be confirmed. Conclusions: Anger exhibited significant direct and indirect associations with insomnia, with cynical distrust and nightmare distress acting as serial mediators in this cross-sectional model. Findings from this cross-sectional study tentatively suggest that future intervention efforts targeting insomnia in nurses might benefit from addressing anger alongside nightmare distress and cynical attitudes; however, experimental studies are needed to confirm whether such interventions would be effective. Full article

Ophicarbonates provide an important natural record of mineral carbonation during serpentinization of ultramafic rocks and therefore offer insight into the mechanisms and limits of CO₂ fixation in low-temperature geological environments. This paper presents a synthesis and process-oriented reinterpretation of stable-isotope published and previously unpublished data, petrographic, and mineralogical evidence for carbonate formation under fluid-limited serpentinization conditions. Using mineralogical constraints together with a compiled δ¹³C–δ¹⁸O dataset that includes legacy measurements from the 1980s–1990s, we evaluate how multi-stage carbonate precipitation reflects evolving water–rock ratio, redox state, transport limitation, and deformation-controlled permeability. Particular attention is given to systematic differences between vein-hosted carbonates and dispersed intergranular or scattered-grain ophicarbonates, as these textural–isotopic relationships help identify fluid flux, carbon source, and reaction progress in ultramafic systems. The analysis shows that carbonation does not proceed uniformly but is restricted to overlapping reactive windows controlled by fluid availability, nucleation kinetics, and permeability evolution. These constraints help explain why carbonation may either intensify or stall during progressive serpentinization. The Author further discuss why kinetic barriers and Mg–Ca partitioning may redirect carbonate mineralogy toward calcite or metastable Mg-rich phases even where dolomite or magnesite may be thermodynamically favored. The results highlight the importance of coupling isotopic signatures with petrographic context in reconstructing carbonation pathways and provide a broader framework for understanding natural mineral sequestration of carbon in heterogeneous serpentinite systems. Full article

The protein folding problem has traditionally been defined by two complementary challenges: predicting the three-dimensional structure of a protein from its amino acid sequence and understanding the mechanism by which this structure is attained. While recent advances in artificial intelligence have largely addressed the former, the latter remains unresolved. Early studies showed that many small proteins fold in a cooperative two-state manner, shifting attention toward transition states and energy landscapes. Comparative analyses of protein families further revealed that folding mechanisms are often conserved among proteins sharing the same topology, suggesting a dominant role of structure in shaping folding pathways. However, this framework does not explain when and how a protein commits to a specific topology. Metamorphic proteins, in which highly similar sequences adopt distinct native folds, provide a powerful complementary approach. Studies of these systems show that closely related sequences can follow different folding mechanisms without sharing common intermediates. These findings indicate that folding pathways are determined at very early stages and are encoded within the denatured ensemble through subtle structural and energetic biases. Here, we review the evolution of protein folding studies and propose a unified view in which folding mechanisms are selected early, with the denatured state playing a central role in defining both folding pathways and final topology. Full article

How AI can contribute to green sustainable development (GSD) in China is a critical yet underexplored question. Leveraging the staggered implementation of the National New Generation Artificial Intelligence Innovation and Development Pilot Zone (AIPZ) as a quasi-natural experiment, this study employs a difference-in-differences approach with panel data from 285 prefecture-level cities (2017–2022). The main findings are threefold. First, AI directly promotes GSD and, more importantly, indirectly enhances GSD by upgrading new-quality productivity (NQP)—a novel mechanism that distinguishes this study from conventional environmental policy evaluations. Second, the facilitating effect is not uniform: significant positive effects are detected in the western, eastern, and central regions, but not in the northeastern region; among major urban agglomerations, the Pearl River Delta, Chengdu-Chongqing, and Yangtze River Deltaexhibit significant effects, whereas the Middle Reaches of the Yangtze River and Beijing-Tianjin-Hebei region does not. Third, spatial spillover analysis reveals that AI’s favorable effect on GSD spreads primarily through intercity similarity in economic development level. These findings provide actionable insights for policymakers aiming to harness AI for sustainable development, highlighting the importance of fostering NQP and designing regionally differentiated strategies. Full article

In this study, the degree and characteristics of sedation were assessed using the Grint scale for azaperone and acepromazine in 24 dogs, with the effects on heart rate and systemic blood pressure evaluated simultaneously using oscillometry. Posture, palpebral reflex, eye position, relaxation, response, postural resistance, attitude, systolic pressure, diastolic pressure, mean arterial pressure, and heart rate were analyzed using linear mixed-effects models to evaluate the effects of treatment, time, and their interaction. Significant effects of time were observed for all variables (p < 0.001), including systolic, diastolic, and mean arterial pressure, whereas heart rate was not significantly affected by treatment. Based on these results, we conclude that azaperone produces moderate sedation at 20 min after administration, and it does not induce bradycardia or clinically significant hypotension. Full article

China’s steel decarbonization is a key sustainability challenge because cleaner production routes must be evaluated not only by their mitigation potential, but also by their implications for industrial continuity, cost affordability, resource security, and transition manageability. This study develops a national-scale soft-linked sustainability assessment framework that translates policy-conditioned macro signals into a multi-period, multi-objective optimization model of steelmaking-route transition from 2025 to 2050. Three policy environments are examined: carbon-control pressure, electricity-cost support for electrified routes, and their combined application. The model evaluates route portfolios by cumulative system cost, emissions, and transition adjustment intensity, linking mitigation with affordability and implementation feasibility. Results show that policy environments do not shift pathways uniformly; instead, they reshape the feasible trade-off frontier and alter which route combinations emerge as plausible compromise solutions. Across scenarios, scrap-based electric arc furnace steelmaking (Scrap-EAF) becomes the central medium-term route, while blast furnace–basic oxygen furnace steelmaking (BF-BOF) contracts but remains residual. Hydrogen-based direct reduced iron–electric arc furnace steelmaking (H₂-DRI-EAF) expands under favorable conditions, but does not become dominant by 2050 under the baseline national-scale parameterization. Overall, this study contributes to sustainability-oriented industrial transition analysis by showing how policy-conditioned environments reshape route feasibility, transition sequencing, affordability–mitigation trade-offs, and the practical manageability of China’s steel-sector decarbonization. Full article

Introduction: The role of Collis gastroplasty has traditionally been reserved for patients with a shortened esophagus due to chronic gastroesophageal reflux disease (GERD). However, its necessity has been questioned, leading to a decline in popularity. This systematic review and meta-analysis aimed to evaluate the efficacy of hiatal hernia repair with fundoplication, with versus without Collis gastroplasty. Methods: A systematic search of Ovid MEDLINE, Ovid Embase, Scopus, Web of Science Core Collection, and the Cochrane Library (via Wiley) was performed in May 2025. Studies were included if they compared outcomes or the safety profile of Collis gastroplasty versus no Collis gastroplasty during fundoplication for hiatal hernia repair. Meta-analyses were conducted using a random-effects model and restricted maximum likelihood. Results: Of 664 unique results, 17 studies comprising 4048 patients were included. There was a female predominance (65.4%), with a weighted mean age of 58.9 ± 14.0 years and follow-up of 43.5 ± 43.1 months. Patients who underwent Collis gastroplasty represented 35.8% of the cohort. Nissen fundoplication was the most common procedure in both the Collis (91.9%) and non-Collis (84.5%) groups. Most studies had selection bias, in which only patients who did not have sufficient intraoperative intra-abdominal esophageal length underwent Collis gastroplasty. Recurrence rates were similar (13.5% vs. 13.2%). Collis gastroplasty was not associated with a reduction in hiatal hernia recurrence (OR 0.53, 95% CI 0.23–1.22). Symptom outcomes, including regurgitation (OR 0.53, 95% CI 0.05–5.39), reflux (OR 0.81, 95% CI 0.03–22.12), dysphagia (OR 1.12, 95% CI 0.62–2.04), and use of antireflux medication on follow-up (OR 1.15, 95% CI 0.62–2.15), were not significantly different. However, Collis gastroplasty was associated with a higher risk of complications, including overall complications (OR 2.63, 95% CI 1.55–4.46), leak (OR 3.35, 95% CI 1.11–10.05), and surgical site infection (OR 8.28, 95% CI 1.16–59.10). There were no significant differences in abscess formation (OR 5.97, 95% CI 0.77–46.49), length of stay (mean difference 0.36 days, 95% CI −0.30 to 1.01), readmission (OR 1.13, 95% CI 0.36–3.60), reoperation (OR 1.24, 95% CI 0.64–2.41), or mortality (OR 1.08, 95% CI 0.45–2.57). Conclusions: Collis gastroplasty was not associated with a decreased risk of hiatal hernia recurrence or improvement in other efficacy measures, but this is in the context of a strong component of selection bias. In this context, there may be a role for Collis gastroplasty in difficult cases if the rate of recurrence does not differ from those with sufficient length, but this must be balanced against a significantly increased risk of complications. Full article

NanoArduSiPM represents a paradigm shift in the ArduSiPM (Architected Detection Unit for Silicon Photomultipliers) roadmap, evolving from a standalone instrument into a high-density modular building block (36 mm × 42 mm × 3 mm, 7 g). This revision does not merely pursue miniaturization; it re-engineers the signal-processing chain to maintain high performance within a scaled-down footprint, enabling the transition from single-unit detection to scalable, distributed multi-detector systems. NanoArduSiPM is based on a three-layer architecture comprising an external scintillator and Silicon Photomultiplier (SiPM) detection module, a dedicated high-speed discrete analog front-end, and a System-on-Chip (SoC) for embedded acquisition and processing. The physical implementation adopts high-integrity PCB routing and rigorous isolation techniques designed to suppress digital–analog coupling, a critical requirement in such a compact form factor. This deterministic layout strategy provides the architectural foundation for time-tagging capabilities, currently under quantitative characterization, by addressing the fundamental sources of signal interference at the hardware level. Beyond hardware integration, NanoArduSiPM introduces the capability for extended firmware functionality, including event tagging via external inputs and the implementation of coincidence and veto logic. This framework supports the acquisition of multiple correlated histograms and allows multiple units to be interconnected on a shared SPI bus. By shifting from standalone operation to a coordinated, hierarchical architecture, NanoArduSiPM enables distributed detection schemes where event selection and correlation are handled natively within the system, reducing the dependency on external data acquisition electronics. The compact modular architecture, together with the high-performance discrete analog front-end and embedded data handling, makes NanoArduSiPM suitable for applications where low mass and low power consumption are critical, targeting applications such as space-based payloads, laboratory instrumentation, remote sensing, and large-scale distributed multi-channel detection systems. While no radiation-tolerance qualification of the complete system has been performed in this work, the microcontroller family used in the design is also available in radiation-tolerant variants, which may support future implementations targeting more demanding radiation environments. Full article

Traditional Peruvian cuisine has become a globally recognized experience, but its impact on visitors to the Caral Supe archaeological site—one of the oldest centers of civilization in South America and a UNESCO World Heritage Site—has not been studied. The main objective was to explain the constructs of the perceived authenticity of traditional food, loyalty to traditional food, service quality at traditional restaurants, and tourist satisfaction with visits to archaeological sites, based on the experience economy theory. An explanatory study was conducted using a structural equation modeling approach (PLS-SEM), applied to a sample of 381 tourists who visited the archaeological site and consumed local cuisine at restaurants in the destination of Barranca. The findings confirmed significant relationships among the model’s constructs (p < 0.01). It is suggested that the perception of authenticity of traditional food is a determining factor for loyalty (R² = 0.743) and a driver of satisfaction with the visit to the archaeological site (R² = 0.617), which constitutes the study’s contribution. However, the R² value for the construction of the tourist experience at the destination (R² = 0.301), the model does not fully capture the complexity of experiential processes at this particular heritage destination, which may depend on emotional, cultural, or contextual variables not included in this study. Satisfaction with the visit to the archaeological site is primarily related to staff attentiveness, the quality of guide explanations, and safety. It is concluded that the interplay between satisfaction with the visit to the archaeological site, the perceived authenticity of traditional food, and the quality of service in restaurants is fundamental to enhancing the experience at the heritage destination, thereby positioning traditional food and archaeotourism. It is recommended that the public and private sectors design strategies aimed at generating authentic and sustainable experiences for visitors, strengthening factors such as the destination’s reputation, the positive image of the site, satisfaction with the trip at the destination, and the positive experience. Full article

Moyamoya angiopathy (MMA) is a rare, chronic progressive cerebrovascular condition characterized by bilateral stenosis or occlusion of the terminal internal carotid arteries and their major branches. This progressive occlusion triggers the development of telangiectatic and fragile vessels at the base of the brain, creating the characteristic angiographic appearance of a “puff of smoke.” Depending on the etiology, MMA is classified as Moyamoya Disease (MMD) when idiopathic and primary or Moyamoya Syndrome (MMS) when associated with underlying systemic conditions. While the RNF213 gene, particularly the p.R4810K variant, is recognized as the major susceptibility locus for MMD in East Asian populations, it does not fully account for the global genetic landscape or the phenotypic diversity of the disease. This review provides a comprehensive overview of the genetic architecture of the entire MMA spectrum, exploring loci beyond RNF213. We analyze the role of genes involved in vascular smooth muscle cell contractility (ACTA2, MYH11), TGF-β signaling, and DNA repair mechanisms that drive MMS, alongside the genetic basis of syndromic forms associated with neurofibromatosis type 1, trisomy 21, and RASopathies. Understanding these diverse genetic drivers is crucial for early diagnosis, risk stratification, and the development of targeted molecular therapies. Full article

In high-inflation economies, stablecoins are increasingly becoming infrastructural channels through which households and firms access U.S.-dollar value outside traditional financial arrangements. We study Argentina as a fragmented USD access system composed of a regulated official channel, an informal parallel channel (the Blue Dollar), and platform-based USDT channels on Binance and Bitso. Using a quantile time-frequency connectedness framework, we estimate reduced-form dynamic dependence and spillover patterns across these interdependent subsystems under normal and extreme market states and across short- and long-term horizons. Four main findings emerge. First, system-wide connectedness is dominated by short-term transmission and rises sharply during policy regime transitions, particularly around the relaxation of capital controls. Second, under normal conditions, stablecoin markets behave as early-moving net spillover transmitters, whereas the Blue Dollar and the official rate primarily absorb shocks. Third, connectedness exhibits a symmetric U-shaped pattern across quantiles, indicating that tail events intensify cross-channel dependence regardless of shock direction. Fourth, under upper-tail extreme market states, the official rate becomes a net transmitter in the long-term frequency band, implying that major devaluation episodes can temporarily reconfigure the system’s transmission architecture, even though stablecoin channels remain important in overall connectedness. These findings should be interpreted as evidence of dynamic dependence rather than structural causality. They suggest that digital dollarization does not simply add another trading venue; it increases boundary permeability, reshapes information hierarchy, and changes the monitoring problem faced by authorities in fragmented financial systems. Full article

Polymer-based product use is rapidly increasing worldwide, resulting in critical social, environmental, ecological, economic, and health effects. Worldwide efforts have increasingly focused on solutions to the equilibrium consumption, production, and disposal of plastics to tackle these issues. The frontiers of biodegradable and bio-based polymers are continually advancing in pursuit of sustainability. Therefore, designing ecological bioplastics made of both biodegradable and bio-based polymers reveals chances to overcome plastic pollution and resource depletion. Polymeric materials are mainly used to manufacture different products at the beginning of their lifespans and which become waste after usage. Numerous sustainability strategies and polymer recycling methods are described and mostly classified into chemical, mechanical, and thermal recycling processes. This manuscript presents a New Polymers Frontier in Recycling and Sustainability Using an Ensemble of Deep Learning with a Heuristic Search Algorithm (NPFRS-EDLHSA). This work is devoted to computational polymer typology, which is based on machine learning algorithms applied to data on physicochemical properties. Although polymer classification can facilitate downstream materials research, the present study does not directly simulate recycling, environmental impacts, or sustainability. The main contributions made by this work include (i) an exploratory analysis of ensemble deep learning models to classify polymers by type on a small and unbalanced dataset; (ii) an evaluation of the effect of feature selection with a heuristic optimization methodology; and (iii) a comparison of the effects on classification performance under limited data conditions. This research sets out to provide a methodological explanation, not arguments for industrial-scale applicability. For the polymer-type classification process, the proposed NPFRS-EDLHSA model designs an ensemble of deep learning techniques, namely a bidirectional recurrent neural network (BiRNN) model, a bidirectional gated recurrent unit (BiGRU) method, and a graph autoencoder (GAE) technique. Finally, the grasshopper optimization algorithm (GOA) adjusts the hyperparameter values of the ensemble models optimally and results in an improved classification performance. A wide-ranging set of experiments was conducted to validate the performance of the NPFRS-EDLHSA method. The experimental results indicated that the NPFRS-EDLHSA technique achieved a better performance than an existing model. Full article

Background/Objective: Psoriasis is a systemic inflammatory disease often associated with metabolic comorbidities, including hyperuricemia. While biological therapies effectively target inflammatory pathways, their specific impact on serum uric acid (SUA) levels remains debated. This study aimed to evaluate whether biological therapy, while reducing systemic inflammation, influences SUA levels in patients with moderate-to-severe plaque psoriasis. Methods: A prospective longitudinal cohort study was conducted involving 30 patients with moderate-to-severe plaque psoriasis. Patients received biological treatment (adalimumab, secukinumab or ustekinumab) and tsDMARDS (apremilast). Clinical severity was assessed using the Psoriasis Area and Severity Index (PASI). C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), SUA levels and other laboratory markers were measured at baseline and after 48 weeks of therapy. Results: Biological therapy led to a significant reduction in PASI scores (from 21.6 ± 10.7 at baseline to 0.4 ± 0.86 after 48 weeks of therapy, p < 0.001), and CRP decreased from a median of 5.75 mg/L at baseline to 3.55 mg/L, p < 0.001. ESR also declined from 26.2 ± 11.4 mm/h to 19.0 ± 8.06 mm/h, p < 0.001. However, no statistically significant change was observed in mean SUA levels 5.49 ± 1.55 vs. 5.55 ± 1.60 mg/dL; p = 0.758. Subgroup analysis revealed that SUA levels remained stable regardless of the specific biological agent used or the degree of clinical improvement. Conclusions: Our findings suggest that while biological therapy is highly effective in controlling skin and systemic inflammation in psoriasis, it does not modify SUA levels. These results imply that hyperuricemia in psoriasis may be driven by metabolic factors independent of the primary inflammatory pathways targeted by current biologics. Full article

The integration of environmental, social and governance (ESG) criteria into corporate and financial decision-making has become one of the most significant transformations in today’s financial markets. Growing regulatory pressure, stakeholder expectations and increased awareness of sustainability challenges have led companies and investors to incorporate ESG considerations into strategic and investment decisions. Despite the rapid spread of ESG practices, the academic literature presents conflicting and sometimes contradictory evidence regarding their economic implications and practical effectiveness. This article provides a review of the literature on the main academic contributions to ESG integration, focusing on three key dimensions: the economic benefits associated with ESG practices, the methodological and credibility challenges relating to ESG measurement, and the organisational and technological factors that enable effective ESG implementation. The findings indicate that ESG integration is generally associated with positive organisational outcomes, including improved financial performance, lower cost of capital, greater stakeholder trust and a reduction in firm-specific risk. However, the realisation of these benefits is not automatic and depends to a large extent on the credibility of ESG practices and information. Rather than endorsing the widely held view that ESG criteria are inherently capable of creating value, the analysis shows that the value-creating effect of ESG criteria depends crucially on the credibility of ESG practices and the quality of their implementation. The literature highlights significant methodological challenges, including rating divergence, the lack of standardised metrics, methodological opacity and the growing risk of greenwashing, which can undermine the reliability of ESG information. This paper proposes an deductive conceptual framework in which ESG effectiveness emerges from the interaction between value creation mechanisms, credibility constraints, and enabling organisational and technological factors. Full article