Search Results (984)

Coastal reclamation reshapes both soils and vegetation, yet their coupled trajectories remain poorly understood. Here we investigated soil–vegetation co-evolution across a 15-year chronosequence on Hengsha Island in the Yangtze River estuary. The reclaimed soils were formed primarily from dredged estuarine silt and clay slurry deposited during hydraulic filling. Four representative sites were studied, spanning 3 (Y3), 7 (Y7), 10 (Y10), and 15 (Y15) years since reclamation. Soil physicochemical properties (pH, electrical conductivity, salinity, nitrogen, phosphorus, potassium) were measured, while vegetation cover was quantified using NDVI and fractional vegetation cover (FVC) derived from satellite data. Soil conditions improved markedly with reclamation age: pH, conductivity, and salinity declined, whereas nitrogen, phosphorus, and potassium accumulated significantly (p < 0.001). Vegetation shifted from salt-tolerant pioneers (e.g., Suaeda salsa, Phragmites australis) to mixed communities and cultivated rice fields (Oryza sativa), reflecting progressive improvements in soil quality. Vegetation cover increased in parallel, with NDVI rising from 0.12 ± 0.05 (Y3) to 0.35 ± 0.09 (Y15), reflecting a shift from salt-tolerant pioneers to structurally complex communities. Mantel tests revealed strong positive associations of NDVI with organic matter, nitrogen, and phosphorus, and negative associations with pH, conductivity, and salinity. Structural equation modeling identified organic matter and nitrogen enrichment, along with declining pH and dissolved salts, as dominant drivers of vegetation recovery. These results highlight a co-evolutionary process in which soil improvement and vegetation succession reinforce one another, offering insights for ecological restoration and sustainable management in coastal reclamation landscapes. Full article

Background/Objectives: Relapsing polychondritis (RP) is a rare autoimmune disorder marked by recurrent inflammation of cartilaginous tissues, including the airways. Airway involvement, such as subglottic stenosis and airway malacia, significantly impacts prognosis. Although spirometry is the standard for evaluating respiratory function, it may be unfeasible in patients with severe airway narrowing or tracheostomy. This study evaluated the potential of a smartphone-based application, DepthRecorder, which uses the iPhone’s TrueDepth camera to analyze thoracic motion in real time. Methods: Twelve patients with RP were enrolled. All underwent simultaneous respiratory assessment using spirometry and the DepthRecorder application. Thoracic motion data were corrected for height using previously validated regression formulas. Correlation between DepthRecorder and spirometry values was analyzed using Spearman’s rank correlation for forced vital capacity (FVC), forced expiratory volume in one second (FEV₁), and the FEV₁/FVC ratio. Results: Mean age was 53.8 ± 13.3 years, with equal numbers of males and females. Before correction, DepthRecorder showed moderate correlations for FEV₁ (ρ = 0.48, p = 0.003) and FEV₁/FVC (%) (ρ = 0.57, p < 0.001). After correction, stronger correlations were observed for FVC (ρ = 0.76, p < 0.001), FEV₁ (ρ = 0.72, p < 0.001), and FEV₁/FVC (%) (ρ = 0.60, p < 0.001). Conclusions: The DepthRecorder application demonstrated strong correlations with spirometry following height-based correction. This method may offer a practical, non-invasive tool for respiratory assessment in RP patients who cannot undergo conventional lung function testing. Further studies are needed to validate these findings and establish clinical reference standards. Full article

Background/Objectives: Accurate prognostication for interstitial lung disease (ILD) remains challenging, limiting clinicians’ ability to optimize patient management strategies. This study aimed to evaluate the prognostic value of baseline quantitative CT-derived indices, including total lung volume (TLVcm³), normal lung volume% (NLV%), and fibrotic lung volume% (FLV%), for predicting three-year mortality in interstitial lung disease (ILD) patients. Methods: A total of 101 ILD patients were retrospectively enrolled. Baseline CT-derived indices, including TLVcm³, NLV% (−950 to −700 HU), and FLV% (−600 to +50 HU), were measured on chest CT. Baseline forced vital capacity(FVC)% predicted and diffuse capacity of lungs for carbon monoxide (DLCO)% predicted were collected. Survival analysis used Kaplan–Meier’s curves and log-rank tests. Uni- and multivariate Cox’s proportional hazards regression were performed. Pearson’s correlation was used between CT-derived indices, FVC% predicted, and DLCO% predicted. Results: During 3-year follow-up, 30 of 101 patients (29.70%) died. Deceased patients had a significantly lower baseline NLV% (59.27% ± 7.61% vs. 65.02% ± 7.82%, p = 0.001) and a higher FLV% (17.64% ± 7.98% vs. 13.34% ± 7.48%, p = 0.011) compared with survivors. Multivariate analysis identified baseline NLV% (adjusted hazard ratio 0.88, 95% CI: 0.78–0.99, p = 0.034) and DLCO% predicted (adjusted hazard ratio 0.97, 95% CI: 0.95–0.99, p = 0.007) as independent predictors of three-year mortality. Patients with NLV% ≤ 64.15 and FLV% ≥ 14.12 showed significantly worse survival outcomes (21.78% vs. 7.92%, p < 0.001;19.80% (20/101) vs. 9.90% (10/101), p < 0.001). CT-derived indices moderately correlated with FVC% predicted and DLCO% predicted. Conclusions: Baseline FLV% ≥ 14.12 and NLV% ≤ 64.15 can effectively stratify and differentiate outcomes in ILD patients. Baseline NLV% has the potential as a prognostic indicator for 3-year survival in ILD. Full article

Background: Severe asthma is associated with an increased risk of osteoporosis, largely due to chronic corticosteroid exposure and persistent systemic inflammation. Data from different international registries indicate a significant prevalence of osteoporosis among patients with severe asthma, with large variations attributed to differences in treatment strategies and optimization of care. Aims and Methods: This study aims to assess the prevalence of osteoporosis among patients with severe asthma enrolled in the Severe Asthma Network Italy (SANI) registry who are receiving treatment with monoclonal antibodies (mAbs) and/or long-acting muscarinic antagonists (LAMAs) and compare the characteristics of patients with and without osteoporosis to identify key risk factors contributing to osteoporosis. Results: A total of 1813 patients receiving Step 5 GINA (mAbs, LAMAs) treatment were included in the final analysis, of whom 282 (15.5%) had osteoporosis. Osteoporosis prevalence was significantly higher in women (20.3%) compared to men (8.0%). The prevalence also increased with age (p < 0.001) and with asthma duration (p = 0.008). Patients with osteoporosis exhibited poorer asthma control, lower lung function (FEV1 and FVC), a higher rate of exacerbations, and more frequent chronic oral corticosteroid (OCS) use compared to those without osteoporosis. Nasal polyposis was not significantly associated with osteoporosis in this cohort. Conclusions: Osteoporosis is highly prevalent in individuals with severe asthma, mainly due to chronic corticosteroid exposure and persistent inflammation, and is associated with asthma duration, sex, age, frequent exacerbations, cumulative exposure to OCS, and reduced lung function. Early recognition of osteoporosis risk is essential, and biologic therapies offer a promising strategy to reduce OCS dependence, mitigate adverse effects, and improve long-term outcomes. Full article

Background: Nitric oxide (NO)-related biomarkers, including asymmetric dimethylarginine (ADMA), nitric oxide (NO), and endothelial nitric oxide synthase (eNOS), may play a role in the pathophysiology and clinical progression of chronic obstructive pulmonary disease (COPD). This study aimed to investigate their diagnostic value in stable COPD and acute exacerbation. Methods: A total of 150 participants (76 females, 74 males; mean age 53.82 ± 7.06 years) were enrolled and equally distributed into control, stable COPD, and acute exacerbation groups (n = 50 each). Demographic, clinical, and laboratory parameters were compared across groups. Serum ADMA, NO, and eNOS levels were analyzed, and correlations with clinical findings were evaluated. ROC analysis was performed to determine the diagnostic performance of the biomarkers. Results: Serum ADMA levels were significantly higher in COPD patients, particularly in the acute exacerbation group (p < 0.05 for all comparisons). In contrast, NO and eNOS levels were significantly lower in COPD groups compared to controls (p < 0.05 for all comparisons). ADMA showed strong negative correlations with FEV₁, FEV₁/FVC, PaO₂, and SaO₂, whereas NO and eNOS showed positive correlations with the same parameters (all p < 0.01). For predicting acute exacerbation, an ADMA cut-off of 1.36 yielded high diagnostic accuracy (AUC = 0.983; sensitivity 86.0%; specificity 96.0%). eNOS also demonstrated predictive value (AUC = 0.823). For stable COPD, NO at a cut-off of 14.91 showed excellent diagnostic performance (AUC = 0.921). Conclusions: NO-related biomarkers, particularly ADMA and NO, may serve as reliable indicators for differentiating between stable COPD and acute exacerbation. Elevated ADMA and reduced NO and eNOS levels were closely associated with impaired lung function and oxygenation parameters. These findings suggest potential clinical utility of these biomarkers in COPD monitoring and management. Full article

Background/Objectives: In patients with idiopathic pulmonary fibrosis (IPF), a progressive disease characterized by lung tissue scarring, the impact of comorbidities is only partially understood. In particular, the prognostic implications of pulmonary hypertension (PH) are yet to be fully disclosed. Methods: To identify distinct IPF phenotypes on the basis of comorbidities and functional data, we performed cluster mixed data retrospective analysis, as well as recursive partitioning analysis on a dataset of 324 patients from the European IPF Registry (eurIPFreg); all patients were classified as IPF on the basis of established guidelines. Diagnosis of PH was based on echocardiographic and right heart catheter criteria as indicated in the 2022 ESC/ERS guidelines. Results: Two distinct clinical clusters with significant survival differences were identified (p < 0.001). Cluster 1, with fewer comorbidities, had a median survival of 4.41 years, whereas Cluster 2, with higher rates of arterial hypertension, diabetes mellitus, cardiovascular disease, PH, and dyslipidemia, showed a shorter median survival of 2.85 years. Multivariate Cox regression analysis confirmed PH as a significant predictor of reduced survival (HR 2.03). Recursive partitioning (RP) revealed that FVC was the strongest prognostic indicator: FVC below 50% predicted poor survival, and among patients with a FVC above 50%, the presence of PH indicated a significantly worse outcome. Conclusions: In this real-world IPF cohort, comorbidity cluster and RP analysis identified PH as the most relevant comorbidity. The findings suggest that PH may be more prevalent and impactful in IPF than previously recognized, with implications for clinical management. Full article

Background: Severe asthma is a chronic, difficult-to-treat disorder that significantly affects quality of life, and oral glucocorticosteroids are usually required. Many patients suffering from severe asthma exhibit T2 inflammation and may benefit from biological treatment. This study aims to evaluate changes in cytokine concentrations during therapy with benralizumab, dupilumab, and mepolizumab in severe eosinophilic asthma. Materials and Methods: In this prospective, single-center study, 39 patients with severe eosinophilic asthma received treatment with one of the above-mentioned biologics. Parameters, such as the cytokine profile (Human Th9/Th17/Th22 Luminex, Performance Assay 18-plex Fixed Panel, R&D Systems, Minneapolis, MN, USA) and additionally the Asthma Control Questionnaire (ACQ), mini-Asthma Quality of Life Questionnaire (mini-AQLQ), spirometry (FEV1, FEV/FVC), FeNO, and functional status, were assessed at baseline and after 3–4 months of therapy. Results: The biologic therapies demonstrated diverse effects on inflammatory biomarkers. Dupilumab showed the most pronounced decreases in CD40L, IL-6, and FeNO in comparison to other drugs. In turn, the greatest decrease in TNF-α concentration was observed in the group treated with mepolizumab. Conclusion: Changes in cytokine concentrations highlight the heterogenous immunomodulatory mechanisms of biologics and support personalized strategies based on inflammatory profiles. However, the results should be interpreted with prudence, as the concentrations of cytokines in blood serum fluctuate and the study sample size is small. Full article

Northern Thailand experiences annual haze events with fine particulate matter (PM2.5) exceeding standards, posing risks to schoolchildren. This cross-sectional study (Chiang Mai, 2024) evaluated respiratory impacts among primary school children aged 8–12 years. Daily mean PM2.5 concentrations were obtained from a single fixed-site monitoring station (36T) located within 2 km of the spirometry site. Among 93 children with acceptable spirometry, 52% exhibited restrictive, 18% obstructive, and 30% had normal function. After adjustment for BMI, males had significantly lower odds of any pulmonary abnormality than females (AOR = 0.084; 95% CI 0.017–0.417; p = 0.002). The mean FEV₁/FVC ratio was normal (86.30 ± 13.07%), whereas mean FVC, FEV₁, and PEF were significantly below predicted values, indicating a predominantly restrictive pattern. This predominance likely reflects cumulative exposure to biomass-burning related PM2.5 during the haze season, infiltration of outdoor PM2.5 into indoor environments alongside indoor sources, and the vulnerability of developing lungs in children’s factors that reduce lung volumes while largely preserving the FEV₁/FVC ratio. The exposure assessment provides pragmatic, proximity-based estimates but is limited by reliance on one station and one season, which may not capture spatial or temporal variability. These findings highlight sex-based susceptibility and support stronger air quality protections for children. Full article

Background: Sarcoidosis is a systemic granulomatous disease with a highly variable clinical course, and distinguishing it from other diseases and predicting its prognosis can be challenging. In recent years, hematological and biochemical parameters have been investigated as potential biomarkers for assessing inflammation and predicting disease prognosis. This study aimed to evaluate the prognostic value of the lactate dehydrogenase-to-albumin ratio (LAR), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and lymphocyte-to-monocyte ratio (LMR). Methods: This retrospective, single-center study included 369 newly diagnosed patients with sarcoidosis who were admitted between January 2020 and October 2024. Sarcoidosis was diagnosed based on current ERS, ATS, and WASOG guidelines. At the 6-month follow-up, patients’ clinical courses were classified as regression, stable, or progression based on clinical, radiological, and pulmonary function tests. The predictive values of various hematological and biochemical parameters were analyzed using statistical methods, including binary logistic regression analysis and ROC analysis. Results: A total of 369 patients were included in the study. At the 6-month follow-up, 63.4% of patients showed regression, 21.4% had a stable course, and 15.2% showed progression. The progression group had a significantly higher LAR (5.26 [4.21–7.76]) compared to the stable/regression group (4.59 [3.82–5.86]) (p = 0.033). Additionally, baseline FVC% (OR, 0.97; p = 0.036) and the presence of dyspnea (OR, 3.08; p = 0.03) were identified as independent risk factors for disease progression. No significant associations were found between NLR, PLR, LMR, and serum ACE levels and the clinical course. The cutoff value of LAR for predicting disease progression was 4.87 (AUC: 0.605), with a sensitivity of 58.8% and specificity of 59.7%. Conclusions: Our study, which is the first to evaluate the prognostic value of LAR in sarcoidosis, identified this parameter as a significant indicator for the clinical course. The finding of significantly higher LAR levels in patients with disease progression suggests its potential as a prognostic biomarker. These results may help guide treatment and follow-up strategies, although further large-scale prospective studies are needed for validation. Full article

Background: Liberation from mechanical ventilation is a major objective in critically ill patients. Various criteria for extubation are used with different success rates. We developed a novel, simple bedside maneuver and index that involves measuring breath-hold duration and forced vital capacity (FVC). We named it the Respiratory Breath Hold Index (RBHI). Methods: We enrolled 225 mechanically ventilated intensive care unit (ICU) patients who were candidates for extubation. At the end of a spontan eous breathing trial (SBT), and just prior to extubation, patients were asked to hold their breath and perform a stalked FVC maneuver. The ability to perform a breath-hold maneuver and its duration were recorded and compared with a standard SBT. Results: 171 patients (76%) were successfully extubated, while 54 patients (24%) failed extubation. A successful SBT alone did not predict extubation, as 80.1% of passed SBT and 81.5% of failed SBT patients were extubated successfully (p = 1.00). However, a higher RBHI, together with the ability to hold breath and breath-hold duration, was highly associated with a successful extubation (p < 0.0001). Logistic regression analysis showed that RBHI over 3 was correlated with higher rates of successful extubation (OR 4.252, p < 0.001). Overall, 89% of patients who passed SBT and were able to hold breath were successfully extubated. (p < 0.0001). Whereas, among patients who passed SBT but failed to hold breath, only 24% were successfully extubated (p < 0.0001). Conclusion: Higher RBHI, together with the ability to hold a breath just prior to extubation in mechanically ventilated patients, is more sensitive and specific, and may be superior to standard SBT in predicting a successful extubation. Full article

Background: Dupilumab, a monoclonal antibody targeting the IL-4/IL-13 receptor, has shown significant efficacy in improving asthma control and reducing exacerbations in patients with severe eosinophilic asthma. However, there is a lack of knowledge about real-world data on clinical remission rates and their predictors. Objective: This study aimed to evaluate clinical outcomes, remission rates, and predictive factors of remission in a real-life cohort of patients with severe eosinophilic asthma treated with dupilumab. Methods: We conducted a retrospective, bicentric, observational study including 52 patients with severe eosinophilic asthma treated with dupilumab. Clinical, functional, and biomarkers were assessed at baseline, 6 months, and 12 months. Statistical analyses included logistic regression to identify independent predictors of clinical remission. Results: After 12 months of treatment, 48.2% of patients achieved clinical remission. Dupilumab significantly improved asthma control and lung function (including FVC and FEF_25–75), reduced exacerbation rates, and maintenance therapy. High blood eosinophil levels (>490 cells/µL), high FeNO levels (>25 ppb), a history of CRSwNP, and better baseline FEV1 were associated with asthma remission. Conversely, obesity (BMI > 30) and related comorbidities (such as GERD, OSAS, and hypertension) and bronchiectasis were associated with a lower likelihood of remission. Multivariate analysis confirmed higher baseline FEV1 (OR 2.94; IC 1.13–7.6), positive history of CRSwNP (OR 8.03; IC 1.41–45.5), and higher baseline blood eosinophils (OR 1.003 IC 1.001–1.006) as independent predictors of clinical remission. Conclusions: These results are in line with the known effectiveness of dupilumab in severe eosinophilic asthma and identified a history of CRSwNP, higher baseline FEV1, and elevated blood eosinophils as key predictors of clinical remission. These findings may contribute to a more personalized approach to treatment selection, emphasizing the importance of comorbidity assessment together with type 2 inflammation biomarkers. Further prospective studies are needed to validate these results. Full article

Background/Objectives: Some lung transplant (LungTx) recipients do not achieve the expected lung function within the first year, a condition known as baseline lung allograft dysfunction (BLAD). Our objective was to analyze the risk factors associated with BLAD, focusing on the variables associated with a higher risk of developing a more intense alloimmune response. Methods: We carried out a prospective study including 88 LungTx recipients. BLAD was defined as failure to reach 80% of the predicted value for forced expiratory volume in one second (FEV1) and/or forced vital capacity (FVC) on two tests conducted at least three weeks apart. Tacrolimus time in therapeutic range (TTR) and mycophenolic acid area under the curve (MPA AUC_0–12h) were measured at the third month. Donor–recipient compatibility was assessed using HLA eplet mismatch analysis, performed via HLA Matchmaker 3.1. Results: BLAD patients showed greater eplet mismatch burden (67, IQR 20 vs. 55, IQR 22, p = 0.018) and had been exposed to a lower TTR (26.6%, IQR 14.0% vs. 39.6%, IQR 24.3%, p = 0.039) and less frequently to an adequate third-month MPA AUC_0–12 > 30 mg × h/L (57.1% vs. 89.2%, p = 0.020). DR/DQ eplet mismatches (β = −0.348, p = 0.002) and third-month MPA AUC_0–12 (β = 0.285, p = 0.009) were independently associated with six-month predicted FEV1%. Conclusions: Among other variables, BLAD and initial lung graft function are associated with greater eplet discordance and lower immunosuppressive drug exposure, suggesting a potential role of underlying alloimmune responses in their pathogenesis. Full article

The Yellow River Basin (YRB), a pivotal ecoregion in China, has long been plagued by a range of ecological problems, including water loss, soil erosion, and ecological degradation. Despite previous reports on the ecological environment of YRB, systematic studies on the multi-factor driving mechanism and the coupling between the ecological and hydrological systems remain scarce. In this study, with multi-source remote-sensing imagery and measured hydrological data, the random forest (RF) model and the geographical detector (GD) technique were employed to quantify the dynamic spatiotemporal changes in the ecological environment of YRB in 2000–2024 and identify the driving factors. The variables analyzed in this study included gross primary productivity (GPP), fractional vegetation cover (FVC), land use and cover change (LUCC), meteorological statistics, as well as runoff and sediment data measured at hydrological stations in YRB. The main findings are as follows: first, the GPP and FVC increased significantly by 37.9% and 18.0%, respectively, in YRB in 2000–2024; second, LUCC was the strongest driver of spatiotemporal changes in the ecological environment of YRB; third, precipitation and runoff contributed positively to vegetation growth, whereas the sediment played a contrary role, and the response of ecological variables to the hydrological processes exhibited a time lag of 1–2 years. This study is expected to provide scientific insights into ecological conservation and water resources management in YRB, and offer a decision-making basis for the design of sustainability policies and eco-restoration initiatives. Full article

Forward head posture and altered scapular alignment are associated with musculoskeletal dysfunctions and impaired physical performance. However, the relationship between postural alignment indices and physiological function in young adults remains unexplored. A total of 54 healthy participants (mean age: 21.88 ± 2.06 years) were evaluated. Craniovertebral angle (CVA) and scapular index were measured as indicators of postural alignment. Upper trapezius muscle tone was assessed using the MyotonPRO device. Pulmonary function parameters, including the forced vital capacity (FVC) and forced expiratory volume in one second (FEV₁)/FVC, were measured using spirometry. Balance control was evaluated using the Tetrax system, and cervical proprioception was assessed using joint position error (JPE) tests. CVA showed statistically significant but weak correlations with the muscle tone (r = −0.191), weight distribution index in the eyes-open condition (r = −0.199), and cervical flexion JPE (r = −0.198) and a positive correlation with FVC (r = 0.251) (p < 0.05). Scapular index showed a positive correlation with FEV₁/FVC (r = 0.241) and a negative correlation with balance control (r = −0.213) (p < 0.05). Improved postural alignment, as reflected by a higher CVA and scapular index, was associated with reduced muscle tone, enhanced pulmonary function, better balance control, and more accurate cervical proprioception. Full article

Largescale vegetation reconstruction projects in the western and northern parts of China, along with climate change and increased humidity, have significantly boosted fractional vegetation cover (FVC) in the Mu Us Desert. However, this increase may impact the area’s vulnerability to drought stress. Here, we assessed the area’s susceptibility to hydrometeorological drought by analyzing the maximum correlation coefficients (MCC) derived from the spatiotemporal relationships between FVC and estimates of standardized precipitation evapotranspiration index (SPEI) for the area. The results of the study were as follows: (1) FVC exhibited an increasing trend throughout the growing seasons from 2003 to 2022. Although the region experienced an overall wetting trend, drought events still occurred in some years. MCC-values were predominantly positive across all timescales, suggesting that vegetation generally responded favorably to drought conditions. (2) The order of response of land covertype to drought, from greatest to lowest, was grassland, cultivated land, forestland, and sand land. Cultivated land and grassland exhibited heightened sensitivity to short-term drought; forestland and sand land showed greater sensitivity to long-term drought. (3) With a high FVC, the response of grassland and sand land to drought was significantly enhanced, whereas the response of cultivated land and forestland was less noticeable. (4) Low FVC grassland and sand land have not yet reached the VCCSW threshold and can support moderate vegetation restoration. In contrast, forestland and cultivated land exhibit drought sensitivity regardless of FVC levels, indicating that increasing vegetation should be approached with caution. This research offers a method to evaluate the impact of drought stress on ecosystem stability, with findings applicable to planning and managing vegetation cover in arid and semiarid regions globally. Full article