Saved Queries

Peripartum depression (PPD) represents one of the most prevalent and disabling psychiatric conditions among women, yet its underlying biology remains poorly integrated across medical disciplines. Emerging evidence highlights PPD as a prototypical disorder of the heart–brain axis, where neuroendocrine changes, immune activation, and cardiovascular dysregulation converge to shape maternal vulnerability. During pregnancy and the postpartum period, abrupt fluctuations in estrogen, progesterone (P4), and placental corticotropin-releasing hormone (CRH) interact with a sensitized hypothalamic–pituitary–adrenal (HPA) axis, altering neural circuits involved in mood regulation, stress reactivity, and maternal behavior. Parallel cardiovascular adaptations, including endothelial dysfunction, altered blood pressure variability, and reduced heart rate variability (HRV), suggest a profound perturbation of autonomic balance with potential long-term implications for maternal cardiovascular health. Neuroinflammation, microglial activation, and systemic cytokine release further mediate the bidirectional communication between the heart and the brain, linking emotional dysregulation with vascular and autonomic instability. Evidence also indicates that conditions such as preeclampsia and peripartum cardiomyopathy share biological pathways with PPD, reinforcing the concept of a unified pathophysiological axis. This review synthesizes current knowledge on the neurobiological, cardiovascular, endocrine, and inflammatory mechanisms connecting PPD to maternal heart–brain health, while discussing emerging biomarkers and therapeutic strategies aimed at restoring integrative physiology. Understanding PPD as a multisystem heart–brain disorder offers a transformative perspective for early detection, risk stratification, and personalized intervention during one of the most biologically vulnerable periods of a woman’s life. Full article

(This article belongs to the Section Reproductive and Developmental Biology)

►▼ Show Figures

Figure 1

16 pages, 1855 KB

Open AccessArticle

Long-Term Follow-Up in Patients with Large-Vessel Vasculitis Applying Extracranial and Transcranial Duplex Sonography

by Johanna Härtl, Sebastian Lambrecht, Felix Hess, Achim Berthele, Silke Wunderlich and Enayatullah Baki

Diagnostics 2026, 16(3), 455; https://doi.org/10.3390/diagnostics16030455 (registering DOI) - 1 Feb 2026

Abstract

Background: Although large-vessel vasculitis (LVV) can affect both the anterior and posterior intracranial circulation, routine neurosonographic follow-up, including transcranial duplex sonography, has not been established. We aimed to characterize patients with giant cell arteritis (GCA) and Takayasu arteritis (TAK) regarding the detection of progressive or new-onset inflammatory vessel changes by using neurosonography, and to assess the impact on medical or interventional treatment strategies. Methods: We retrospectively identified all patients with LVV treated at our neurological department between January 2015 and October 2025 with at least one neurosonographic follow-up examination. Baseline and follow-up sonographic data, clinical characteristics, medical therapy, and interventional treatments were analyzed. Results: In total, 21 LVV patients (GCA, n = 16; TAK, n = 5) underwent sonographic follow-up (GCA: median 28 (2–106) months, 4.5 (2–33) sonographic assessments; TAK: 75 (33–255) months, 14 (4–60) sonographic assessments). Isolated or combined, progressive or new-onset intra- and extracranial arterial disease was detected in seven of the 16 GCA patients (43.8%), of whom three (18.8%) presented with ischemic stroke. Medical treatment was adapted in four progressive cases. In two patients, additional interventional treatment was performed. Among TAK, two of five (40%) patients showed progressive sonographic changes, with one patient experiencing an ischemic stroke requiring endovascular treatment for progressive common carotid artery stenosis and one patient showing asymptomatic intracranial ICA involvement. Conclusions: Progressive and symptomatic involvement of intracranial carotid and vertebral arteries is a frequent finding in patients with LVV. These changes can be effectively detected through comprehensive neurosonographic follow-up, including transcranial ultrasound assessment. Full article

(This article belongs to the Special Issue Advances in the Diagnosis and Management of Vasculitis)

21 pages, 2058 KB

Open AccessReview

Food Waste in Hospitals: Determining Factors and Sustainable Strategies for Mitigation

by Camila Burgoa Sánchez and Adriano Costa de Camargo

Sustainability 2026, 18(3), 1458; https://doi.org/10.3390/su18031458 (registering DOI) - 1 Feb 2026

Abstract

Food waste generated by hospitalized patients represents a significant challenge with environmental, economic, and social implications. In this context, Sustainable Development Goal 12, which promotes responsible consumption and production patterns, highlights the urgency of reducing this waste as an essential measure to mitigate climate change, optimize resource use, and improve the sustainability of health and food systems. This study presents a narrative review of the literature, complemented by a bibliometric analysis, aimed at synthesizing the available evidence on food waste in hospitals. Based on the identification of 746 records in different databases published between 2019 and 2024, studies focusing on the determining factors, quantification methods, and sustainable strategies to mitigate hospital food waste were included. The lack of menu personalization, the perceived low quality of food, operational disorganization, and reduced patient appetite are identified as relevant factors associated with waste at the hospital level, while direct weighing remains the most accurate quantification method. The sustainable strategies reviewed can reduce food waste and improve hospital sustainability; however, there remains limited assessment of their long-term impact. Our results highlight the urgent need to address food waste in hospitals through the implementation of comprehensive, evidence-based strategies. Full article

(This article belongs to the Special Issue Sustainability Through Circularity: Food Waste Challenges and Opportunities)

►▼ Show Figures

Figure 1

32 pages, 8278 KB

Open AccessReview

4D Printing in Regenerative Medicine: Bio-Inspired Applications for Dynamic Tissue Repair

by Guanyi Liu, Jinan Wu, Yang Yang, Junsi Luo and Xiaoli Xie

J. Funct. Biomater. 2026, 17(2), 72; https://doi.org/10.3390/jfb17020072 (registering DOI) - 1 Feb 2026

Abstract

4D printing, as an advanced evolution of 3D bioprinting, introduces time as an active design dimension, enabling printed constructs to undergo programmed morphological or functional transformations in response to external or endogenous stimuli. By integrating stimuli-responsive smart materials with precise additive manufacturing, 4D printing provides a bio-inspired strategy to overcome the inherent limitations of static scaffolds and to achieve spatiotemporal dynamic matching with the evolving biological microenvironment during tissue regeneration. Over the past decade, significant progress has been made in applying 4D printing to structurally and functionally complex tissues, including bone, muscle, vasculature, nerve repair, wound closure, and other emerging biomedical scenarios. Rather than emphasizing shape change alone, recent advances demonstrate that 4D-printed constructs can emulate key biological processes such as morphogenesis, contraction, directional guidance, electrophysiological signaling, and microenvironment-responsive regulation, thereby enhancing tissue integration and functional recovery. This review systematically summarizes materials, stimulus–response mechanisms, and representative applications of 4D printing from a bio-inspired perspective, while critically discussing current challenges related to material performance, mechanistic understanding, manufacturing precision, and clinical translation. Finally, future perspectives are outlined, highlighting the importance of interdisciplinary integration, intelligent manufacturing, and clinically oriented evaluation frameworks to advance 4D printing toward personalized and precision regenerative medicine. Full article

(This article belongs to the Section Biomaterials for Tissue Engineering and Regenerative Medicine)

►▼ Show Figures

Figure 1

18 pages, 347 KB

Open AccessArticle

Energy Poverty in the Era of Climate Change: Divergent Pathways in Hungary and Jordan

by Mohammad M. Jaber, Eszter Siposné Nándori and Katalin Lipták

Urban Sci. 2026, 10(2), 75; https://doi.org/10.3390/urbansci10020075 (registering DOI) - 1 Feb 2026

Abstract

This study examines the interrelated challenges of climate change and energy poverty across two distinct industrial regions: Borsod-Abaúj-Zemplén in Hungary and Zarqa in Jordan. Both areas face unemployment and low-income levels, as well as environmental legacies of industrial activity; however, they differ significantly in their energy policies and infrastructure development. Using 2025 survey data, we develop indices of energy poverty, financial poverty, and climate perceptions, aligned with OECD guidelines. Regression analysis indicates that the model accounts for approximately 40% of the variance in energy poverty. Notably, heightened perceptions of climate change are associated with increased reports of energy hardship, suggesting that economically deprived households possess greater climate risk awareness. Resilience capacities, including adaptive skills, income stability, and community support, are found to substantially mitigate energy poverty. Income and employment status also play protective roles, underscoring the importance of economic resources. The impact of financial poverty varies markedly, being negligible in Hungary but severe in Jordan due to structural and infrastructural constraints. Our findings underscore the need for tailored, inclusive policy interventions that emphasize energy efficiency and retrofitting in Hungary and promote financial support and the adoption of renewable energy in Jordan. Integrating principles of energy justice into climate resilience strategies is crucial for promoting equitable and sustainable energy transitions, mitigating local vulnerabilities, and enhancing overall household resilience. Full article

(This article belongs to the Special Issue Urban Energy Districts: Innovation, Sustainability, and Sharing for a Solidary Future)

►▼ Show Figures

Figure 1

20 pages, 2676 KB

Open AccessArticle

Antitumor Effects of PD-1 Blockade Combined with Mild Hyperthermia in a Murine Osteosarcoma Model

by Yuya Izubuchi, Naoi Hosoe, Takaaki Tanaka, Yumiko Watanabe, Tatsunobu Kobayashi, Hideaki Nakajima, Hiroyasu Kidoya and Akihiko Matsumine

Biomedicines 2026, 14(2), 341; https://doi.org/10.3390/biomedicines14020341 (registering DOI) - 1 Feb 2026

Abstract

Background: Osteosarcoma remains largely refractory to immune checkpoint inhibitor (ICI) monotherapy, and strategies to modulate the tumor immune microenvironment are being actively explored. Mild hyperthermia has been reported to influence antitumor immune responses; however, its impact in combination with PD-1 blockade in osteosarcoma has not been well characterized. Methods: Murine LM8 osteosarcoma cells were subjected to mild thermal stimulation, and changes in PD-L1 expression were evaluated. LM8-bearing mice were treated with mild hyperthermia, anti-PD-1 antibody, or their combination. Tumor growth, lung metastasis, and survival were assessed. Tumor-infiltrating immune cells were profiled using single-cell RNA sequencing to descriptively characterize immune-associated transcriptional features under each treatment condition. Results: Mild thermal stimulation (42 °C, 30 min) increased PD-L1 expression in LM8 cells in vitro. In vivo, combination therapy significantly suppressed primary tumor growth compared with control (χ² = 29.75, p = 1.6 × 10⁻⁶) and reduced lung metastasis burden, with a significant decrease in metastatic nodules (p < 0.01). Kaplan–Meier analysis demonstrated a significant survival benefit in the combination group (log-rank p < 0.001). Single-cell RNA sequencing revealed an increased proportion of CD8⁺ T cells with reduced exhaustion-associated gene expression and a shift toward pro-inflammatory (M1-like) macrophage transcriptional profiles. Conclusions: PD-1 blockade combined with mild hyperthermia was associated with enhanced antitumor efficacy and immune-associated transcriptional remodeling in a murine osteosarcoma model, supporting further preclinical evaluation of this combination strategy. Full article

(This article belongs to the Section Immunology and Immunotherapy)

►▼ Show Figures

Figure 1

36 pages, 8227 KB

Open AccessArticle

Analysis of Precipitation and Regionalization of Torrential Rainfall in Bulgaria

by Krastina Malcheva, Neyko Neykov, Lilia Bocheva, Anastasiya Stoycheva and Nadya Neykova

Climate 2026, 14(2), 39; https://doi.org/10.3390/cli14020039 (registering DOI) - 1 Feb 2026

Abstract

The increasing frequency of extreme rainfall events that cause severe damage is considered a clear sign of climate change. Therefore, analyzing these events and gaining a better understanding of the circulation patterns that form precipitation regimes and trigger torrential rainfall are crucial for developing adaptation strategies. This study aims to present a comprehensive picture of precipitation regimes in Bulgaria under contemporary climate conditions, investigate the connections between precipitation and atmospheric circulation patterns, and propose a regionalization of torrential rainfall. We used daily precipitation data collected in the period 1991–2020, along with data on hazardous rainfall warnings issued by the National Institute of Meteorology and Hydrology. To identify the circulation patterns associated with both rainy days and hazardous rainfall in Bulgaria, we applied the automated Jenkinson–Collison classification. To identify precipitation patterns, we conducted a principal component analysis in T-mode with varimax rotation and k-means clustering of component scores on both monthly normals and a dataset of 166 selected torrential rainfall days. The results, examined in the context of the existing regionalization of precipitation, highlight the climatic diversity of precipitation regimes in Bulgaria. Our findings indicate that torrential rainfall is associated with low-pressure systems and airflows mainly from the east or northeast, as well as with weak-gradient pressure fields. Full article

(This article belongs to the Section Weather, Events and Impacts)

►▼ Show Figures

Figure 1

25 pages, 11268 KB

Open AccessArticle

Multiphysics Field Coupling Analysis and Highly Robust Control Strategy with Coupling Functions of Vehicle-Mounted Flywheel Battery

by Xiaoyan Diao, Hongyuan Yin, Weiyu Zhang and Duyuan Lian

Actuators 2026, 15(2), 86; https://doi.org/10.3390/act15020086 (registering DOI) - 1 Feb 2026

Abstract

The vehicle-mounted flywheel battery is a complex assembly of multiple components that is subject to intense multi-physical field coupling and external disturbances, which lead to real-time changes in system parameters and reduce control performance. The aim of this study is to enhance the robustness and dynamic stability of the system under emergency avoidance conditions. Its internal multiphysics field coupling is intricate, and external disturbances further intensify the cross-coupling. Building upon this method, a highly robust control strategy with real-time coupling characteristic parameters is designed in this study. First, a bidirectional coupling method combining electromagnetism, heat, and structure fields was proposed. This method captured the dynamic interactions among the magnetic, thermal, and structural fields. Based on this analysis, a coupling characteristic function was extracted to quantify the real-time coupling strength. Then, this function was mapped into the parameters of the sliding mode controller. Adaptive gain adjustment can be achieved without relying on an accurate system model. The key assumptions include linear material properties within the operational temperature range and negligible unsteady turbulence effects in airflow. Full article

(This article belongs to the Special Issue Magnetic Levitation and Actuator Integration: From Fundamental Research to Emerging Applications)

►▼ Show Figures

Figure 1

67 pages, 12423 KB

Open AccessReview

Nonlinear Earth System Dynamics Determine Biospheric Structure and Function: I—A Primer on How the Climate System Functions as a Heat Engine and Structures the Biosphere

by Timothy G. F. Kittel and Kelly Ferron

Climate 2026, 14(2), 38; https://doi.org/10.3390/cli14020038 (registering DOI) - 1 Feb 2026

Abstract

The Earth’s climate system exhibits nonlinear behavior driven by interactions among the atmosphere, oceans, cryosphere, land, and biosphere. These dynamics have given rise to relatively stable environments that shape the structure and function of the modern biosphere. This review is a primer for conservation practitioners and natural resource managers to develop a deep understanding of how the Earth System works. The key is to recognize that shifts in Earth System dynamics due to global climate change can destabilize the biosphere in unforeseen ways. The potential emergence of novel ecoregions must be a critical factor in adaptation planning for conservation and resource management. We review how thermodynamic constraints and global circulation dynamics determine the distribution of terrestrial and marine biomes. These dynamics stem from the Earth System functioning as a heat engine, transporting excess heat from low to high latitudes. We illustrate how biome climates are organized into climate regimes, with spatial and temporal characteristics linked to complex features of atmospheric and oceanic circulation. At centennial to millennial scales, these dynamics have created a stable envelope of natural variability in climate that has established a long-standing operating space for biota. However, this stability is becoming increasingly uncertain due to the growing positive energy imbalance in the Earth System primarily driven by anthropogenic greenhouse gas emissions. This forcing is leading to disruptive climatic change, putting the biosphere on a trajectory toward new transient states. Such global to regional climatic instability and biospheric restructuring introduce a high level of uncertainty in ecological futures, with major implications for natural resource management, biodiversity conservation strategies, and societal adaptation. We conclude by discussing frameworks for impact assessments and decision making under climate uncertainty. Full article

(This article belongs to the Special Issue Climate System Uncertainty and Biodiversity Conservation)

►▼ Show Figures

Figure 1

21 pages, 2455 KB

Open AccessReview

Mussel Production in the Global Blue Food System: Current Status, Sustainability Challenges, and Future Trajectories

by Fan Li, Hai-Jie Gao, Yun-Lin Ni and Peng-Zhi Qi

Fishes 2026, 11(2), 86; https://doi.org/10.3390/fishes11020086 (registering DOI) - 1 Feb 2026

Abstract

This review examines the status, challenges, and future trajectories of global mussel aquaculture within the blue food system. Despite steady production growth, mussels’ relative contribution to total bivalve output has significantly declined over recent decades due to disproportionate expansion of oyster, clam, and scallop sectors. A major geographical production shift has occurred, with Asia, spearheaded by China, emerging as the dominant region, supplanting traditional European producers while the Americas rapidly ascend. China’s overwhelming dominance in overall bivalve production starkly contrasts with its underdeveloped mussel sector, where growth lags behind other bivalves despite substantial absolute increases, reflecting a fundamental restructuring of species composition. The industry faces interconnected sustainability constraints: persistent vulnerabilities in spat supply stemming from environmental variability, hatchery limitations, and disease transmission risks; escalating environmental stressors including climate change impacts, harmful algal blooms, pollution, and pathogens; structural flaws in value chains characterized by fragmented production, market volatility, and underutilized byproducts; and governance challenges related to spatial access and licensing inefficiencies. This review advocates for a comprehensive strategy to boost the mussel aquaculture. These encompass advancing hatchery technology and genetic breeding programs, implementing ecosystem-based management such as multi-trophic systems and AI-enhanced environmental monitoring, restructuring value chains through producer cooperation and high value product diversification, and establishing science-based spatial planning frameworks with streamlined governance. Addressing these challenges holistically is critical to position mussel farming as a resilient pillar of sustainable blue food production capable of reconciling ecological integrity with economic viability and social equity. Full article

►▼ Show Figures

Figure 1

38 pages, 18597 KB

Open AccessReview

Advances in Machine Learning Approaches for UAV-Based Remote Sensing in Data-Deficient Antarctic Environments

by Brittany Gorry, Juan Sandino, Peyman Moghadam, Felipe Gonzalez and Jonathan Roberts

Remote Sens. 2026, 18(3), 459; https://doi.org/10.3390/rs18030459 (registering DOI) - 1 Feb 2026

Abstract

Remote sensing plays a vital role in monitoring environmental change in Antarctica, offering non-invasive insights into ice dynamics, biodiversity, and fragile ecosystems. Harsh conditions, limited field access, and logistical challenges result in sparse, noisy, and often unlabelled datasets, posing major obstacles for machine learning (ML) approaches. Data scarcity remains a fundamental challenge for uncrewed aerial vehicle (UAV)-based ecological monitoring. While ML models in other Earth observation domains demonstrate state-of-the-art performance, their applicability in Antarctic and polar regions’ settings is limited. This paper reviews the intersection of ML and UAV-based remote sensing in Antarctica under extreme data constraints. We surveyed recent strategies designed to overcome these limitations, including self-supervised learning, physics-informed modelling, and foundation models. Results highlight a notable gap, as polar environments remain excluded from global datasets and benchmarks due to the extensive data requirements of large-scale models. Opportunities exist where multimodal and multi-scale generalisation can enhance cross-domain adaption to data-scarce use cases. Unlike prior reviews on general remote sensing or task-specific polar studies, this work uniquely underscores the need for Antarctic representation in global ML advances, positioning Antarctica as a frontier testbed for machine learning in extreme, inaccessible, and under-resourced fields. Full article

(This article belongs to the Special Issue Advanced Machine Learning Models for Remote Sensing Applications and Data Analysis—Recent Developments)

►▼ Show Figures

Figure 1

27 pages, 3946 KB

Open AccessArticle

Contrasting Response of Santina and Bing Sweet Cherry Cultivars Under Combined Biotic and Abiotic Stress

by Claudia Carreras, Alan Zamorano, Camila Gamboa, Luis Villalobos-González, Paula Pimentel, Lorena Pizarro, Weier Cui, Manuel Pinto, Carlos Rubilar-Hernández, Analía Llanes, Assunta Bertaccini and Nicola Fiore

Plants 2026, 15(3), 450; https://doi.org/10.3390/plants15030450 (registering DOI) - 1 Feb 2026

Abstract

Climate change is intensifying the simultaneous occurrence of biotic and abiotic stresses in fruit crops, but yet the molecular mechanisms underlying plant responses remain poorly understood. The physiological and transcriptomic responses of two sweet cherry (Prunus avium L.) cultivars, Santina and Bing, grafted onto Gisela 12, were investigated under single and combined stresses imposed by Pseudomonas syringae pv. syringae and water deficit. Although biomass, gas exchange, and hormone accumulation showed only minor changes, combined stress triggered distinct cultivar-dependent transcriptional reprogramming. The cultivar Bing exhibited a pronounced response with 4261 differentially expressed genes (DEGs), characterized by strong repression of photosynthetic processes and activation of defense- and hormone-related pathways. In contrast, the cultivar Santina showed a moderate response with 674 DEGs, primarily reinforcing structural and secondary metabolism. Cultivar-specific modulation of abscisic acid sensitivity was associated with the contrasting regulation of WRKY40 and Sin3-like repressors, despite comparable ABA levels. Strikingly, both cultivars upregulated the GIGANTEA gene, underscoring its role as a central regulatory hub linking circadian rhythm, stomatal function, and hormonal crosstalk under dual stress. Collectively, these results reveal non-additive, genotype-specific transcriptional strategies in sweet cherry trees, providing insights into stress integration in fruit trees and identifying regulatory genes that may inform breeding and management strategies for resilience under climate change. Full article

(This article belongs to the Special Issue Plants 2025—from Seeds to Food Security)

►▼ Show Figures

Figure 1

68 pages, 2064 KB

Open AccessArticle

Dual-Leverage Effects of Embeddedness and Emission Costs on ESCO Financing: Engineering-Driven Design and Dynamic Decision-Making in Low-Carbon Supply Chains

by Liurui Deng, Lingling Jiang and Shunli Gan

Mathematics 2026, 14(3), 522; https://doi.org/10.3390/math14030522 (registering DOI) - 1 Feb 2026

Abstract

Against the backdrop of carbon quota trading policies and Energy Performance Contracting (EPC), Energy Service Companies (ESCOs) engage in supply chain emission reduction via embedded low-carbon services. However, the impact mechanism of their financing mode selection on emission reduction efficiency and economic benefits has not been fully revealed, and there is a lack of support from a systematic theoretical and engineering design framework. Therefore, this study innovatively constructs a multi-agent Stackelberg game model with bank financing, green bond financing, and internal factoring financing. We incorporate the embedding degree, emission reduction cost coefficient, and financing mode selection into a unified analysis framework. The research findings are as follows: (1) There is a significant positive linear relationship between supply chain profit and the embedding degree. In contrast, the profit of ESCOs shows an inverted “U-shaped” change trend. Moreover, there is a sustainable cooperation threshold for each of the three financing modes. (2) Green bond financing can significantly increase the overall emission reduction rate of the industrial supply chain in high-embedding-degree scenarios. However, due to emission reduction investment cost pressure, ESCOs tend to choose bank financing. (3) The dynamic change of the emission reduction investment cost coefficient will trigger a reversal effect on the financing preferences of the supply chain and ESCOs. This study unveils the internal mechanism of multi-party decision-making in the low-carbon industrial supply chain and is supported by cross-country institutional evidence and comparative case-based analysis, providing a scientific basis and engineering design guidance for optimizing ESCO financing strategies, crafting incentive contracts, and enhancing government subsidy policies. Full article

(This article belongs to the Special Issue Modeling and Optimization in Supply Chain Management)

23 pages, 4844 KB

Open AccessArticle

Change Point Monitoring in Wireless Sensor Networks Under Heavy-Tailed Sequence Environments

by Liwen Wang, Hongbo Hu and Hao Jin

Mathematics 2026, 14(3), 523; https://doi.org/10.3390/math14030523 (registering DOI) - 1 Feb 2026

Abstract

In the special case of a heavy-tailed sequence environment, change point monitoring in wireless sensor networks faces many serious challenges, such as high communication overhead, particularly sensitivity to sparse changes, and dependence on strict parameter assumptions. In order to solve these limitations, a distributed robust M-estimator-based change point monitoring (DRM-CPM) method is proposed. This method combines ratio statistics with sliding window technology so that in online detection, there is no need to know the distribution before and after changes in advance. A threshold-triggered communication strategy is introduced, where sensors exchange local statistics only when exceeding predefined thresholds, significantly reducing energy consumption. By means of theoretical analysis, the asymptotic characteristics of the statistics are confirmed, and the robustness of the algorithm to heavy-tail noise and unknown parameters is also proved. Simulation results show that the algorithm is better than the existing methods in terms of empirical size control, empirical power, and communication efficiency, particularly in the face of sparse variation or heavy-tailed data. This framework provides a scalable solution for real-time anomaly monitoring with non-Gaussian data characteristics in industrial and environmental applications. Full article

(This article belongs to the Section D1: Probability and Statistics)

18 pages, 930 KB

Open AccessArticle

The Combined Use of Hydroxymethylbutyrate and Branched-Chain Amino Acids to Counteract Uremic Sarcopenia

by Giulia Marrone, Manuela Di Lauro, Kevin Cornali, Sabri Shamsan Hassan, Gabriele D’Urso, Luca Di Marco, Sara Dominijanni, Roberto Palumbo, Anna Paola Mitterhofer and Annalisa Noce

Nutrients 2026, 18(3), 483; https://doi.org/10.3390/nu18030483 (registering DOI) - 1 Feb 2026

Abstract

Background: Hemodialysis (HD) patients frequently develop muscle wasting and chronic inflammation, conditions associated with functional decline and reduced quality of life (QoL). Nutritional strategies that provide targeted anabolic support without increasing nitrogen load may offer clinical benefits. The aim of this study was to evaluate the possible impact of a food for special medical purposes (FFSMP), composed of free-form branched-chain amino acids, β-hydroxy-β-methylbutyrate, and zinc, on muscle mass and strength, laboratory parameters, physical performance (PP), and QoL in HD patients. Methods: in this randomized double-blind crossover study, 24 adult HD patients received the FFSMP (10 g/day; two sachets) supplementation or placebo for 12 weeks, separated by an 8-week wash-out (protocol code RS 29.23). Measured outcomes included quadriceps rectus femoris thickness (QRFT) muscle, body composition analysis, inflammatory markers, oxidative stress indices, other routine biochemical parameters, PP, and QoL (SF-36 questionnaire). Results: FFSMP supplementation resulted in significant increases in QRFT and in fat-free mass percentage. Reductions in oxidative stress and inflammatory biomarkers were observed. Routine biochemical parameters remained stable, with the exception of a decrease in pre-dialysis urea. Functional performance measures did not differ between treatment periods. Improvements were noted in selected SF-36 domains, specifically energy/fatigue and general health. No major adverse events occurred during the study. Conclusions: In HD patients, this FFSMP produced favorable changes in markers of muscle mass and systemic inflammation without affecting short-term physical performance. These findings support the potential clinical utility of targeted amino acid supplementation in this patient population, highlighting the need for larger, longer-term trials. Full article

(This article belongs to the Section Proteins and Amino Acids)

►▼ Show Figures

Figure 1

Show export options Show export options

Select all

Export citation of selected articles as:

Error

Oops... you haven't selected anything for export.

Displaying article 1-50 on page 1 of 631.

Go to page 1 2 3 4 5

Search Results (31,516)

Further Information

Guidelines

MDPI Initiatives

Follow MDPI