Search Results (4,528)

Background: Micro- and nano-plastics (MNPs) are pervasive environmental contaminants that accumulate in various tissues, including the placenta. Experimental and clinical studies suggest potential cytotoxic, oxidative, and inflammatory effects that may lead to placental dysfunction and adverse obstetric outcomes. However, high-quality evidence on the clinical relevance of MNPs exposure during pregnancy remains scarce, underscoring the need for systematic evaluation of their impact on maternal and fetal health. Methods: The databases PubMed, ScienceDirect, CENTRAL, Embase, MDPI and Google Scholar were searched for studies published up to September 2025 investigating the relationship between MNPs and obstetric outcomes. Results: Twelve studies were included in this review, with half employing an observational design in human subjects and the other half using experimental studies in murine models. Although the available evidence is limited, there are studies reporting the association between MNPs exposure and premature birth, low birth weight, intrauterine growth restriction, and miscarriage. The most prevalent polymer detected was polyethylene, and the most commonly used MNPs detection techniques were Raman microspectroscopy, digital microscopy, Fourier Transform Infrared, and Pyrolysis gas chromatography-mass spectrometry. Conclusions: This systematic review summarizes current limited insights on the potential effects of MNPs on obstetric outcomes, highlighting possible associations with low gestational age, low birth weight, intrauterine growth restriction, and miscarriage. Findings do not allow causal inference due to heterogeneity in study design, exposure assessment, contamination control, and analytical methodologies. Full article

Achieving sustainable development requires decoupling economic growth from environmental degradation. In this context, this study examines the effects of tourism arrivals on CO₂ intensity and energy intensity, two key indicators of environmental sustainability aligned with SDGs 7 and 13. Panel autoregressive distributed lag (ARDL) and nonlinear ARDL models are employed using a balanced panel of 54 countries over the period 1996–2023. In addition, Wald tests for long-run asymmetry, dynamic multiplier analysis, and Dumitrescu–Hurlin causality tests are applied. The results confirm the existence of stable long-run relationships between tourism arrivals and both CO₂ intensity and energy intensity. In the symmetric framework, tourism growth is associated with significant long-run reductions in CO₂ and energy intensity, while short-run effects are negative and significant only for CO₂ intensity. In the asymmetric framework, positive tourism shocks generate stronger and more persistent reductions in both intensity measures, whereas negative shocks lead to weaker environmental efficiency gains. Moreover, the Wald test shows the existence of long-run asymmetry between positive and negative tourism shocks. In addition, the dynamic multiplier analysis confirms that environmental intensity adjusts gradually over time following tourism shocks. Finally, Dumitrescu–Hurlin causality tests indicate bidirectional Granger causality relationships between tourism arrivals and environmental intensity indicators. The findings are robust to dynamic endogeneity, the COVID-19 shock, and country heterogeneity. Overall, the findings indicate that tourism arrivals contribute to lowering long-term environmental intensity, consistent with relative decoupling and the goals of sustainable tourism development. Full article

Background: Population ageing has increased the number of older adults living in nursing homes, where loneliness and sleep disturbances are prevalent and negatively affect well-being. Evidence suggests a bidirectional relationship between loneliness and sleep quality, although research in institutionalised populations remains limited. Objectives: This study aimed to characterise the sociodemographic and health profile of nursing home residents in Northern Portugal and examine associations between sleep quality, loneliness, sociodemographic and health variables. Methods: A cross-sectional study was conducted with 157 older adults (≥65 years) across 13 nursing homes. Data were collected using a sociodemographic questionnaire and the Portuguese version of UCLA Loneliness Scale, Pittsburgh Sleep Quality Index and Montreal Cognitive Assessment. Pearson correlations and hierarchical multiple regression analyses were performed. Results: Participants were predominantly female (72.6%), widowed (55.4%), and aged ≥80 years. Most reported chronic conditions (98.7%) and limitations in activities of daily living (75.2%). Age showed modest positive correlations with loneliness. Loneliness dimensions were strongly associated with poorer sleep quality and greater daytime dysfunction. Hierarchical regression revealed that sociodemographic variables explained only a small proportion of variance in sleep quality. The addition of loneliness variables increased explained variance to 38.1%, highlighting loneliness as a key psychosocial predictor. Conclusions: Loneliness significantly influences sleep quality among older adults living in nursing homes. Interventions should integrate strategies to enhance social engagement alongside sleep hygiene measures. Longitudinal studies are recommended to clarify causal pathways. Full article

Although risk factors for Alzheimer’s disease (AD) involve obesity and elevated low-density lipoprotein (LDL) cholesterol levels, and Lonicera caerulea has been reported to improve lipid metabolism disorders (LMDs), it remains unknown whether Lonicera caerulea can simultaneously modulate the progression of both AD and LMDs. In this study, an integrative strategy combining network pharmacology, Mendelian randomization (MR), molecular docking, and molecular dynamics simulations was employed to explore potential targets, pathways, and causal relationships. Network pharmacology and molecular docking results revealed that several blood–brain barrier (BBB)-permeable active components of Lonicera caerulea, including Naringenin and Palmatine, may be associated with targets involved in the lipid and atherosclerosis pathway, such as HSP90AA1, SRC and TNF. These associations indicate a potential link between the modulation of lipid metabolism and AD-related processes, although further validation is required. Molecular dynamics simulations were conducted to support the stability of key docking complexes. Given that elevated LDL is a central feature of LMDs and a key indicator of cholesterol imbalance, MR analysis was conducted to assess its causal relationship with AD. The results provided genetic evidence supporting a causal role of elevated LDL in AD risk, reinforcing the epidemiological link between lipid metabolism and neurodegeneration. These findings imply that BBB-permeable constituents of Lonicera caerulea may exert multi-target effects relevant to AD and LMDs. Enrichment analysis further indicates a possible involvement of pathways associated with lipid and atherosclerosis, supporting its potential as a dietary strategy for at-risk populations. Full article

Tungsten is a critical strategic resource whose supply chain has become increasingly exposed to external trade shocks, raising concerns about its resilience and sustainability. However, existing studies mainly focus on single products and lack a systematic analysis of multi-stage supply chain networks under trade shocks. Using trade data for 66 countries from 2012 to 2023 obtained from the UN Comtrade database, this study constructs a multi-stage trade network of the global tungsten supply chain, covering upstream, midstream, and downstream segments, and combines complex network analysis with a difference-in-differences (DID) approach to examine whether and how Sino–US trade friction affects supply chain resilience. The results show that the trade network exhibits significant structural heterogeneity across segments, with downstream networks being more complex and interconnected; trade friction has no significant effect on upstream and midstream segments but has a significant positive effect on downstream network centrality, indicating stronger adaptability and structural resilience in downstream segments; the results further suggest that the observed downstream adjustment is mainly associated with changes in China’s network position, while the impact on the United States remains statistically insignificant. This study contributes to the literature by integrating network analysis with causal inference in a supply chain framework and provides new evidence on the heterogeneous effects of trade shocks across different stages of strategic resource supply chains under geopolitical risks. Full article

To identify candidate genes associated with skin tissue responses in Hu sheep raised under different regional rearing environments and to preliminarily explore their potential relevance to low-temperature-related environmental responses, this study used 1-year-old female Hu sheep raised in Anhui and Xinjiang as the experimental animals. Skin tissues were collected from the left scapular region, and their transcriptomic profiles were characterized by integrating histological analysis, RNA sequencing (RNA-seq), differential expression analysis, functional enrichment analysis, protein–protein interaction (PPI) network construction, and RT-qPCR validation. The results showed significant differences between the two groups in body weight, body length, body height, cannon circumference, rectal temperature, and ear temperature. Hematoxylin and eosin (H&E) staining indicated that the Xinjiang group exhibited a denser distribution of hair follicles, a relatively thicker dermis, and a more compact arrangement of collagen fibers, suggesting enhanced insulation-related skin characteristics. Transcriptome sequencing identified 295 differentially expressed genes (DEGs), including 193 upregulated and 102 downregulated genes. GO and KEGG enrichment analyses showed that these DEGs were mainly involved in immune and inflammatory responses, redox processes, extracellular matrix remodeling, and lipid and energy metabolism-related pathways, with significant enrichment in cytokine–cytokine receptor interaction, the chemokine signaling pathway, the NF-κB signaling pathway, glutathione metabolism, and drug metabolism–cytochrome P450. By further integrating PPI network analysis and functional annotation, CXCL13, CCL2, FGF21, GPX3, CYP1A1, HSD11B1, CDO1, and STEAP4 were identified as candidate genes. RT-qPCR results showed that the expression trends of the selected genes were generally consistent with the RNA-seq results. Overall, this study revealed differences in phenotypic traits, skin histological structure, and transcriptomic characteristics between Hu sheep raised in different regions, providing preliminary molecular clues potentially associated with low-temperature-related environmental responses. Given the differences in geographic origin and rearing environments between the two groups, the findings should be interpreted as associative evidence of skin transcriptomic responses in Hu sheep under different environmental conditions—rather than as direct causal evidence that low temperature alone drove these transcriptomic differences. Full article

Introduction: Wounds increase the risk of hospitalization in home health (HH) settings by up to 52%. They also consume a notable portion of HH budgets due to frequent nursing visits for wound assessment and care. To address these challenges, a U.S.-based HH enterprise adopted a Digital Wound Care Solution (DWCS) to enhance wound management and operational efficiency. This study examines the impact of integrating the DWCS into practice, focusing on clinical and operational indicators and potential cost savings. Methods: This study employed a quasi-experimental pre–post design to evaluate the impact of the DWCS on clinical and operational outcomes. Data were extracted from the DWCS and EMR databases, encompassing pre-adoption (2022) and post-adoption (2023) periods. The analysis included wound data from 16,276 patients in 2023 and 19,252 patients in 2022, covering an 8-month period (March–October) across 11 branches. The key performance indicators included skilled nursing (SN) visits per episode (VPE), time to complete SN visits, hospitalization rates, and staff optimization. Results: The adoption of the DWCS was associated with clinical and operational improvements. SN VPE decreased by 7.5%, resulting in an estimated annual savings of $1.3 million. A directional change in wound-related hospitalization rates was observed at 30 days (20.7% to 20.3%) and 60 days (32.4% to 31.5%); however, these changes did not reach statistical significance and should be interpreted as trends. The projected prevention of 200 hospitalizations with estimated annual cost savings of $3.4 million to the health system represents modeled projections based on observed directional trends rather than realized savings. A 1.9% shift in staff roles increased the utilization of licensed practical nurses with no adverse indicators identified within the scope of this analysis, saving $112,748 annually. Conclusions: The adoption of the DWCS was associated with fewer and shorter SN visits and a shift toward more LPN utilization, with anticipated reductions in costs Wound-related admissions showed downward trends but did not reach statistically significant levels. This pre–post design precludes causal attribution, and findings should be interpreted as associations rather than definitive effects of the intervention. These findings support further investigation of wound care models integrating AI within a value-based home health setting. Full article

Background and Objectives: We aimed to determine whether gynecologic cancer–related factors are associated with postoperative clinically significant cognitive decline (CCD) after accounting for age and comorbidity using competing-risk models. Materials and Methods: We performed a retrospective cohort study of adult women undergoing index surgery for gynecologic cancer at a tertiary university hospital. CCD was defined as new clinician-documented cognitive impairment, neurology/psychiatry consultation, or initiation of cognition-targeted pharmacotherapy ≥30 days postoperatively. Competing events were all-cause death and major neurologic events/hospice. We fit Fine–Gray subdistribution hazard models adjusted for age, Charlson Comorbidity Index (CCI), cancer stage, and treatment intensity, and evaluated a prespecified age × stage interaction. Results: Among 1023 eligible patients (mean age 62.4 ± 11.8 years; 41.3% International Federation of Gynecology and Obstetrics [FIGO] stage III–IV; median CCI 3 [IQR 2–5]), CCD occurred in 98 (9.6%). The 12-month cumulative incidence of CCD was 11.2% accounting for competing risks. Advanced stage was independently associated with higher CCD risk (sHR 1.85, 95% CI 1.27–2.69; p = 0.001). A significant age × stage interaction was observed (p < 0.001), with the strongest association in patients ≥70 years (sHR 2.48, 95% CI 1.61–3.81). Perioperative factors associated with CCD included open surgery (sHR 1.54) and postoperative delirium (sHR 2.76); these findings should be interpreted as associative signals rather than validated causal treatment targets. A stratified blinded chart review of 160 patients (80 flagged-positive and 80 unflagged controls) supported the CCD definition (PPV 88.8%; sensitivity 72.1%; specificity 94.3%; NPV 91.5%). Visit-frequency adjustment confirmed robustness (advanced stage sHR 1.78; p = 0.003). Conclusions: Gynecologic cancer–related factors, particularly advanced stage, are independently associated with CCD after accounting for competing risks, and high-risk phenotypes (age ≥70, FIGO III–IV) may benefit from perioperative pathways integrating cognitive screening, delirium prevention, and neurocognitive follow-up. Full article

This study aimed to identify candidate molecular pathways mediating dopaminergic dysfunction induced by PFAS mixture exposure, with a focus on the TM/5-HT signaling axis and calcium-linked lipid metabolites, and to explore potential gut-brain axis involvement. Adult mice were exposed to a PFAS mixture. Behavioral tests assessed spatial memory, spontaneous activity, and motor coordination. Histopathological and ultrastructural analyses examined neuronal atrophy, mitochondrial damage, α-synuclein (α-syn), and tyrosine hydroxylase (TH). Transcriptomics, metabolomics, and gut microbiota profiling (16S rRNA sequencing) were performed, followed by integrated multi-omics and correlation analyses. PFAS exposure was associated with PD-relevant motor and cognitive impairments, including impaired spatial memory, reduced spontaneous activity, and motor coordination deficits. Neuronal atrophy, mitochondrial structural damage, upregulation of α-syn, and downregulation of TH were observed. Transcriptomics identified 315 differentially expressed genes (DEGs) enriched in ciliary movement, neuroactive ligand-receptor interactions, and serotonergic synapses. Metabolomics identified 130 differentially abundant metabolites involved in arachidonic acid metabolism and serotonergic synapses. Integrated analysis highlighted correlative changes in the TM/5-HT signaling pathway. Phosphatidylinositol PI(16:0/20:2(11Z,14Z)) showed a strong positive correlation with Dbh gene expression, suggesting a candidate association between Dbh expression and phosphatidylinositol alterations. Gut microbiota analysis revealed compositional alterations (e.g., Muribaculaceae, Ileibacterium) and predicted functional shifts (e.g., tryptophan metabolism–related modules) were observed; these findings are exploratory. This study identifies multi-omics signatures associated with PFAS mixture-induced dopaminergic dysfunction in mice. The TM/5-HT pathway emerges as a candidate molecular axis requiring further investigation. Gut microbiota alterations suggest a potential peripheral component, but causality and gut-brain axis involvement remain hypothetical and need direct experimental validation. Full article

Background: Sedative medications are widely used in intensive care units (ICUs) to facilitate patient management; however, their association with clinical outcomes remains incompletely understood. This study aimed to evaluate the association of cumulative sedative exposure with ICU length of stay (LOS) in a large cohort of critically ill adult patients. Methods: A retrospective observational study was conducted using the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Adult ICU patients (≥18 years) with documented sedative administration were included. Total sedative exposure was quantified as the cumulative dose administered during the ICU stay. The primary outcome was ICU LOS, while the secondary outcome was in-hospital mortality. Patients were stratified into quartiles according to cumulative sedative dose. Multivariable regression analysis was performed to assess the association between total sedative exposure and ICU LOS. Results: A total of 2953 ICU stays were analyzed. Higher cumulative sedative exposure was associated with significantly prolonged ICU LOS. Mean ICU LOS increased from 68.75 h in the lowest quartile to 250.65 h in the highest quartile (p < 0.001). A weak positive correlation was observed between log-transformed total sedative dose and ICU LOS (r = 0.33, p < 0.001). In multivariable analysis, cumulative sedative exposure remained significantly associated with ICU LOS (β = 15.79, 95% CI 14.17–17.41, p < 0.001). No consistent association was identified between sedative exposure and in-hospital mortality. Conclusions: Higher cumulative sedative exposure was associated with longer ICU LOS but not with increased in-hospital mortality. These findings support the importance of carefully tailored sedation strategies in critically ill patients. However, due to the retrospective observational design, causality cannot be inferred, and residual confounding related to illness severity and treatment duration may remain. Full article

Background: Postoperative ileus (POI) remains a leading driver of delayed recovery and prolonged length of stay (LOS) after colorectal surgery. Although ERAS is well established, less is known about how pathway adherence and implementation fidelity relate to bowel recovery in pragmatic minimally invasive practice. Objectives: To evaluate whether a structured ERAS pathway, delivered in routine care, was associated with lower POI and improved early recovery compared with contemporaneous standard care after elective minimally invasive colorectal surgery. Methods: In a prospective, non-randomized pragmatic comparative study conducted from January 2022 to September 2024, 123 adults undergoing elective laparoscopic colorectal resection were managed with either an ERAS pathway (n = 62) or standard care (n = 61). POI was operationalized prospectively using predefined clinical criteria and daily team assessment. Primary outcome was POI. Secondary outcomes included time to flatus, LOS, 48 h opioid use (morphine milligram equivalents, MME), complications (Clavien–Dindo), 30-day readmission, and Quality of Recovery (QoR-15). Multivariable logistic regression and propensity score–adjusted sensitivity analyses were performed to address baseline imbalance. Results: POI occurred in 7/62 (11.3%) in ERAS vs. 22/61 (36.1%) in standard care (p = 0.002). ERAS patients had earlier flatus (38.6 ± 15.2 h vs. 60.0 ± 20.1 h, p < 0.001), shorter LOS (4.2 [3.4–5.0] vs. 5.4 [4.5–6.8] days, p < 0.001), lower 48 h opioids (35.4 [25.2–47.8] vs. 61.1 [41.5–88.6] MME, p < 0.001), and higher QoR-15 at POD2 (113.9 ± 14.9 vs. 104.8 ± 15.5, p = 0.001). In the primary multivariable model, ERAS was independently associated with lower POI odds (adjusted OR 0.2; 95% CI 0.1–0.7; p = 0.013); the association remained directionally similar in propensity-adjusted sensitivity analysis (adjusted OR 0.31; 95% CI 0.12–0.79; p = 0.015). Higher adherence was associated with lower POI and lower opioid exposure. Conclusions: In this prospective cohort, ERAS implementation was associated with lower POI incidence and faster early recovery; however, findings should be interpreted as observational and hypothesis-generating rather than causal. Full article

This study examines whether digital attention can serve as an engagement-based digital attention signal for fintech market performance. Using a revised panel of 70 firm-year observations from seven publicly verifiable fintech and payments firms over 2016–2025, the analysis combines financial outcomes, sector investment indicators, and digital variables related to web traffic, SEO visibility, social media presence, and app popularity. A Digital Attention Index (DAI) was constructed through arithmetic averaging and principal component analysis, with the first component explaining 82.39% of the digital-indicator variance. Fixed Effects models show that the DAI is positively and significantly associated with revenue, market capitalization, and net income, while sector investment is generally weak or insignificant. Out-of-sample validation confirms that panel Fixed Effects specifications outperform pooled OLS, Ridge, and Random Forest models. App popularity is the strongest standalone predictor for revenue and net income, while social media performs best for market capitalization. However, first-difference models weaken most relationships, and Granger tests indicate bidirectional temporal ordering, with financial performance often preceding digital attention. Overall, the findings support the DAI as a useful computational signal of fintech performance, while emphasizing that predictive and causal claims require cautious interpretation. Full article

Background/Objectives: To evaluate the association between fibromyalgia and dementia, with emphasis on temporal directionality and Alzheimer’s disease-related dementia. Methods: We conducted a nationwide, population-based matched case–control study including 9232 patients with fibromyalgia and 46,160 age- and sex-matched controls. Diagnoses in the Leumit Health Services database are recorded using a hybrid coding scheme that combines ICD-9-CM and WHO ICD-10 codes; the specific codes used to ascertain fibromyalgia and each dementia subtype are listed in the Methods. Outcomes were assessed within two predefined windows: up to 20 years before and up to 10 years after fibromyalgia diagnosis. Alzheimer disease-related dementia was defined as the primary outcome. Multivariable logistic regression was used to estimate odds ratios (ORs) with 95% confidence intervals (CIs). Results: During the 20 years preceding fibromyalgia diagnosis, no increased dementia prevalence was observed; Alzheimer disease-related dementia was less frequent among fibromyalgia patients (0.16% vs. 0.31%; absolute difference −0.15 percentage points; OR 0.52, 95% CI 0.31–0.89). In contrast, during the 10 years following diagnosis, fibromyalgia was associated with a higher prevalence of Alzheimer’s disease-related dementia (1.43% vs. 0.99%; absolute difference +0.44 percentage points; OR 1.45, 95% CI 1.18–1.78). No consistent associations were found for other dementia subtypes, which should be interpreted as exploratory given low event counts. Conclusions: Fibromyalgia is associated with a higher prevalence of Alzheimer’s disease-related dementia in the years following diagnosis, with no evidence of pre-diagnostic elevation. Although this temporal pattern argues against reverse causation, the prevalence-based design and residual confounding preclude causal inference. Fibromyalgia should be regarded as a potential risk marker for subsequent Alzheimer-related neurodegeneration rather than a demonstrated causal factor. Full article

Background: The global increase in life expectancy has led to a higher prevalence of age-related cognitive decline, highlighting the need for effective non-pharmacological interventions. This systematic review aimed to evaluate the potential effects of olive oil, particularly its bioactive compounds and fatty acid profile, on cognitive function in adults Methods: A comprehensive literature search was conducted in PubMed, Scopus, and EBSCO in accordance with PRISMA 2020 guidelines, including peer-reviewed studies published in English between 2015 and 2025. A total of six studies met the inclusion criteria and were included in the final qualitative synthesis, comprising five randomized controlled trials and one prospective cohort study. Risk of bias was assessed using the Cochrane Risk of Bias tool (RoB 2) and the Newcastle–Ottawa Scale. Results: The findings suggest that consumption of extra virgin olive oil (EVOO), particularly high-phenolic varieties, may be associated with improvements in cognitive domains such as memory, attention, executive function, and global cognition. However, the evidence is derived from a limited number of heterogeneous studies with relatively small sample sizes. Most of the available data relate to high-phenolic EVOO and olive-derived bioactive compounds, while studies directly examining the role of fatty acid composition remain limited. Proposed mechanisms include reduced blood–brain barrier permeability, enhanced brain functional connectivity, and the neuroprotective effects of compounds such as hydroxytyrosol and oleuropein. Conclusions: While the findings suggest potential cognitive benefits of EVOO, the current evidence remains preliminary and insufficient to establish causality. Therefore, results should be interpreted with caution. Further large-scale, well-designed randomized controlled trials are required to confirm these associations and clarify the specific contributions of fatty acids and bioactive compounds. Full article

Background: Padel is a rapidly growing sport, yet limited evidence is available regarding movement quality and injury history among competitive players. The Functional Movement Screen (FMS) may help describe movement patterns associated with previous injury, although its predictive value remains uncertain. This study examined the association between FMS total and component scores and self-reported injury history among competitive male padel players. Methods: A cross-sectional study was conducted involving 17 competitive male padel players, with 9 injured and 8 uninjured based on self-reported musculoskeletal injury history within the preceding 12 months. Movement quality was assessed using the seven-item FMS. Spearman’s rank correlation was used to examine the association between FMS total score and injury history, while Mann–Whitney U tests were used to compare FMS total and component scores between groups. The seven component-level comparisons were considered exploratory. Bonferroni correction was applied by using an adjusted significance threshold of α = 0.05/7 = 0.007; therefore, unadjusted p-values were interpreted against this corrected threshold. Results: Lower FMS total scores were associated with previous injury history (ρ = −0.703, 95% CI: −0.89 to −0.38, p = 0.002). Previously injured players demonstrated lower FMS total scores than uninjured players (p = 0.005). Among individual components, the In-Line Lunge showed a significant between-group difference after Bonferroni correction (p = 0.004), suggesting lower performance in a task requiring lower-limb stability, mobility, and trunk control. Conclusions: In this small exploratory cross-sectional study, lower FMS scores were associated with self-reported previous injury among competitive male padel players. These findings should be interpreted cautiously, as the study design does not allow causal or predictive conclusions. Larger prospective studies are needed to clarify whether FMS scores have practical value in monitoring movement quality in padel athletes. Full article