Search Results (729)

Lateral epicondylitis (LE), commonly referred to as tennis elbow, remains a frequent cause of lateral elbow pain, yet its optimal management and risk profile are still debated. Therefore, this review aimed to summarize current evidence on its definition, diagnosis, and treatment while addressing common misconceptions. A non-systematic review of major medical databases, including PubMed, Cochrane Library, and Google Scholar, was conducted using predefined inclusion criteria to identify relevant review articles. The analyzed literature highlights that LE is primarily diagnosed clinically and managed through a spectrum of conservative and interventional approaches. Evidence suggests that structured physiotherapy and load modification remain the cornerstones of treatment, while modalities such as platelet-rich plasma and autologous blood injections may offer longer-term benefits compared with corticosteroids, which are effective mainly for short-term symptom relief. In contrast, interventions such as acupuncture and shock wave therapy show limited or inconsistent efficacy. Identified risk factors include female sex, smoking history, repetitive or forceful manual work, and higher cardiovascular risk burden. Overall, conservative management should be the first-line approach, with biologic therapies considered in refractory cases and surgery reserved as a last option; however, further high-quality randomized controlled trials are required to establish optimal treatment algorithms and clarify long-term outcomes. Full article

Background: China’s influenza vaccine (InfV) has undergone multiple iterations and numerous technological breakthroughs, providing tremendous impetus and solid support for the development of China’s health sector. As the number of vaccinated individuals continues to rise, the importance of ongoing surveillance and evaluation of vaccine safety has become increasingly prominent, forming part of efforts to maintain public trust in the national immunization program and ensure its sustainability. Methods: From 2016 to 2025, data on suspected adverse events following immunization (AEFIs) related to InfV administration were extracted from the Chinese National Immunization Information System (CNIIS). Data on InfV vaccination doses were obtained from the Anhui Provincial Immunization Information Management System. A descriptive statistical method was used to analyze the distribution characteristics of AEFIs, and the chi-square test was applied to evaluate differences in reporting rates. Results: Between 2016 and 2025, a total of 4026 AEFI reports related to InfV were monitored through the CNIIS. The overall reporting rate was 34.40 per 100,000 doses. Specifically, common adverse reactions and rare adverse reactions accounted for 95.88% (3860 cases) and 3.38% (136 cases), with reporting rates of 32.98 per 100,000 doses and 1.16 per 100,000 doses, respectively. Among common adverse reactions, the reporting rates of fever (axillary temperature ≥ 38.6 °C), local redness and swelling at the injection site (diameter > 5.0 cm), and local induration (diameter > 5.0 cm) were 9.62 per 100,000 doses, 1.96 per 100,000 doses, and 1.20 per 100,000 doses, respectively. Among rare adverse reactions, the reporting rates of allergic rash, angioedema, anaphylactic shock, febrile convulsions, anaphylactoid purpura, thrombocytopenic purpura, epilepsy, Guillain–Barré syndrome, and aseptic abscess were 0.98, 0.05, 0.03, 0.03, 0.02, 0.02, 0.01, 0.01, and 0.01 per 100,000 doses, respectively. No cases were reported for subunit inactivated influenza vaccine (IIV, Subunit). Statistically significant differences were observed in the reporting rates of allergic rash across different types of InfV (χ² = 36.83, p < 0.05), with trivalent inactivated influenza vaccine (IIV3, Split) and trivalent live attenuated influenza virus vaccine (LAIV3) showing the highest reporting rates. Most adverse events following vaccination occurred within 24 h after inoculation. Conclusions: From 2016 to 2025, the overall reporting rate of AEFIs after InfV administration in Anhui Province was within an acceptable range. Common adverse reactions were common, while rare adverse reactions were few, mainly consisting of allergic reactions. These results indicate that InfV has a favorable safety profile, and continuous strengthening of AEFI surveillance for InfV and improvement of surveillance quality are warranted. Full article

Background: Infectious diseases remain a leading cause of mortality in South Africa, compounded by a high HIV prevalence. This study aimed to delineate the spectrum and clinicopathological characteristics of fatal infectious diseases through a postmortem audit to inform clinical practice and public health strategy. Methods: A retrospective, cross-sectional descriptive study was conducted on all autopsies with a final cause of death attributed to infectious disease at a National Health Laboratory Service, in Northern Pretoria, Gauteng, South Africa, from 2012 to 2021. Using the Systematised Nomenclature of Medicine Clinical Terms (SNOMED) code and word search engines codes, 55 cases were identified. Data on demographics, clinical presentation, HIV status, antiretroviral therapy (ART), comorbidities, and final autopsy diagnosis were extracted from the laboratory information system. Histological confirmation was performed using standard stains. Descriptive statistical analysis was conducted using STATA-18. Results: The cohort (n = 55) had a median age of 31 years (IQR 19–45) and was predominantly female (67%). HIV prevalence was 35%, with 68% of those on ART. The leading cause of death was multilobar pneumonia (36%), followed by bronchopneumonia (22%). AIDS-defining illnesses were present in 27% of cases, with disseminated tuberculosis being the most common (46%). Septic shock was identified in 18% of decedents. A significant proportion (60%) of the cohort was HIV-negative. Conclusions: This autopsy series reveals a high burden of fatal community-acquired pneumonias and HIV-associated opportunistic infections, with a notable proportion of deaths occurring in HIV-negative individuals. The findings underscore diagnostic gaps and highlight the critical role of autopsy in accurate mortality surveillance, advocating for enhanced antemortem diagnostic protocols and targeted public health interventions. Full article

Background: Plantar fasciitis is a common condition likely caused by abnormal foot alignment, such as flatfoot. Insoles are commonly used to treat flatfoot, and systematic reviews have shown that insoles improve pain; however, the underlying mechanism is unclear. This study aimed to investigate the effects of insoles on plantar fascial tension during running in individuals with flatfoot. Methods: The participants were 14 individuals with flatfoot. The task involved running under two conditions: with and without insoles. Insoles that absorbed the shock and supported the medial longitudinal arch were used. The foot marker trajectories and ground reaction forces were measured during running sessions. The plantar fascia tension was estimated based on the ground reaction force, moment arm of the ground reaction force, and that of plantar fascia. Statistical parametric mapping was used to compare the plantar fascia tension during the stance phase between the two conditions. Results: When running with and without insoles, the peak plantar fascial tension was observed at midstance. Planar fascial tension was significantly lower with insoles over a wider range during the stance phase than that without insoles (p < 0.05). Conclusions: This study provided evidence that insoles can reduce plantar pain while running. This result may be useful for reducing pain in individuals with flatfoot and preventing the onset of plantar fasciitis. Full article

E-commerce has reshaped short-term financial management by altering transaction speed, payment structures, and supply chain coordination. This study examines how large publicly listed e-commerce firms, viewed as complex digital business systems, adjusted their working capital policies during and after the COVID-19 shock. The sample is based on the 100 largest e-commerce companies worldwide by market capitalization, as reported by CompaniesMarketCap (February 2026), and is reduced to 76 firms from 23 countries due to data availability, yielding 802 firm-year observations. Firm-level data are obtained from LSEG Datastream, while macroeconomic variables are sourced from the World Bank. The analysis distinguishes between two dimensions of working capital: flow-based operational adjustment, measured by the cash conversion cycle (CCC), and stock-based balance-sheet adjustment, captured by net working capital relative to total assets (WC/TA). Fixed-effects models with firm-clustered standard errors are employed. The results indicate a substantial contraction of the CCC during the pandemic, followed by partial persistence of that contraction rather than a return to pre-pandemic norms. In contrast, WC/TA remains broadly stable during the crisis but declines in the post-pandemic period, suggesting a delayed balance-sheet adjustment. Business-model heterogeneity is not statistically significant, which may reflect a common system-level response across e-commerce firm types. Leverage and supply-chain pressures are associated with working capital intensity (WC/TA), while inflation shapes operate cycle duration (CCC). The findings are consistent with a two-stage adaptive response to systemic disruption. Full article

Introduction: Upper urinary tract infections (UUTIs) are among the most common serious infections during pregnancy and may be associated with maternal and fetal complications. The increasing prevalence of multidrug-resistant pathogens has led to the use of broader-spectrum antibiotics, including meropenem. However, data regarding the safety and efficacy of meropenem in pregnant women remain limited. The aim of this study was to evaluate the indications, efficacy, and safety of meropenem treatment in pregnant women with UUTIs and its impact on maternal and fetal outcomes. Methods: We conducted a retrospective study over a 12-year period including pregnant women hospitalized with UUTIs who received meropenem. The control group consisted of pregnant women with UUTIs who were treated with ceftriaxone during the same period. Results: Pregnant women treated with meropenem were more frequently diagnosed in the third trimester of pregnancy (p = 0.01) and were more often multiparous (p = 0.006). Sepsis and septic shock occurred significantly more frequently in the study group (p < 0.01), and multivariate analysis identified them as the main indications for meropenem administration (OR 10.54, 95% CI 3.30–33.70 for sepsis; OR 3.28, 95% CI 1.01–10.62 for septic shock). Patients in the study group had a higher rate of transfer to the obstetrics clinic (p = 0.032), a longer duration of antibiotic therapy (p = 0.031), and a longer hospital stay (p < 0.01). No maternal deaths were reported in either group. The rate of adverse pregnancy outcomes was similar between the two groups, except for the Apgar score, which was lower in the meropenem group (p = 0.007). Escherichia coli and Klebsiella pneumoniae were the most frequently isolated pathogens in both groups. Conclusions: Meropenem therapy in pregnant women with UUTIs was mainly indicated in cases of sepsis and septic shock and was associated with favorable maternal clinical evolution, even in patients with severe infections. The rate of adverse pregnancy outcomes was similar between the two groups, although a lower Apgar score was observed in the meropenem group; the severity of illness in the meropenem group should be considered when interpreting the lower Apgar scores. Further prospective multicenter studies are needed to better evaluate the safety and clinical effectiveness of meropenem during pregnancy. Full article

This paper documents a fundamental sectoral divergence in capital–employment relationships using UK quarterly data (2014Q1–2024Q4, N = 44). While manufacturing automation studies consistently find negative employment effects, we show that information-intensive service sectors (SIC J: Information and Communication; K: Financial and Insurance; M: Professional/Scientific/Technical) exhibit robust positive co-movement between capital formation and employment. Structural vector autoregression analysis reveals persistent positive employment responses following capital shocks, with effects peaking at 5–6 quarters and remaining significant through 10 quarters. This pattern holds across eight alternative specifications with varying lag structure, variable ordering, and subsample periods. Granger causality tests reveal bidirectional temporal relationships (capital → employment: F = 3.932, p = 0.028; employment → capital: F = 5.659, p = 0.007), indicating joint determination from anticipated demand growth rather than unidirectional technology-driven dynamics. This finding—while complicating causal interpretation—strengthens the contribution by providing honest empirical characterization of coordination mechanisms in information-intensive sectors. Our capital formation proxy measures all investment in AI-intensive sectors (buildings, equipment, conventional IT, emerging AI systems) rather than AI expenditure specifically, creating measurement ambiguity we acknowledge transparently. The sectoral focus (J+K+M sectors with 22–34% AI adoption rates exceeding the 15% economy-wide average) provides indicative evidence that patterns relate to advanced technology deployment, but measurement breadth prevents definitive AI-specific conclusions. The contribution lies not in establishing AI-specific causality—which aggregate time-series methods cannot achieve—but in documenting robust sectoral heterogeneity using methodology comparable to manufacturing displacement studies. The positive association in information-intensive services contrasts sharply with manufacturing’s negative relationship, suggesting technology–employment dynamics vary fundamentally across sectors with different task structures. Three limitations constrain interpretation: (i) recursive identification cannot definitively rule out common demand shocks, (ii) the 44-quarter sample provides limited statistical power for precise magnitude estimation, and (iii) external validity to other countries, time periods, or service sectors remains uncertain. The findings motivate sector-specific rather than economy-wide technology policy approaches, recognizing that extrapolating manufacturing evidence to service-dominated economies may systematically mischaracterize employment dynamics. Full article

This paper examines the drivers of house price cycles across EU countries between 2005 and 2024 and measures their synchronicity. We used panel data methods—fixed effects, dynamic panel models (Arellano–Bond GMM), and a pooled VAR framework—to capture static and dynamic relationships between house price growth and key macroeconomic variables. The results show that the dynamics of house prices are highly persistent. GDP growth has a clear positive effect, while higher unemployment and interest rates push prices down. Migration flows, however, are not statistically significant at the EU aggregate level. Property taxation shows a positive coefficient, which probably reflects structural and institutional differences rather than a direct dampening effect on prices. Dynamic analysis suggests that macroeconomic shocks have persistent and economically meaningful impacts on house price growth. Hierarchical cluster analysis revealed three distinct groups of countries, meaning that house price cycles are only partially synchronized across the EU. Unlike previous studies that typically examine individual determinants or synchronization separately, this study integrates panel econometric methods, dynamic VAR analysis, and hierarchical clustering within a unified framework to jointly assess macroeconomic drivers, dynamic interactions, and structural heterogeneity of house price cycles across EU countries. In general, common macroeconomic drivers and structural heterogeneity coexist—this is important for the stability of the housing market and sustainable development. Full article

Despite geographical proximity and broadly similar agro -climatic conditions, China and Vietnam show sharply divergent coffee export performance, with Vietnam ranking as the world’s second largest exporter, while China’s exports remain modest. This study compares the determinants of their bilateral coffee exports over 2001 to 2022, using a gravity model estimated by Poisson pseudo maximum likelihood with partner and year fixed effects, a specification that retains zero trade flows and absorbs global price and demand shocks. Once these common shocks and fixed bilateral factors are controlled, trading-partner demand characteristics such as GDP, population, and urbanization are not robust determinants of exports for either country. The most consistent determinant is domestic production, which is positively associated with exports for both nations and helps explain their divergent export scale. Domestic consumption cannot be separated cleanly from production, so it is not interpreted as crowding out exports. On the policy dimension, Vietnam’s WTO accession shows a positive association with exports while China’s Belt and Road participation shows none, but these are institutionally different forms of integration and are read as associations, rather than causal effects. The findings carry implications for sustainable development, linking producer competitiveness to livelihoods under Goal 1, growth and decent work under Goal 8, and the balance between domestic and export use of production under Goal 12. Full article

Background: Pancreatic stone protein (PSP) has recently emerged as a novel biomarker with diagnostic and prognostic potential in sepsis. The present study aimed to investigate its role as an early prognosticator in patients presenting to the Emergency Department (ED) with various types of infection. Methods: Point-of-care PSP was measured in 102 consecutive patients (59.8% male) with mean age of 62.7 (±23.4) years, presenting to the ED with suspected or confirmed infection. We examined the utility of PSP to predict adverse events including death, development of septic shock or need for repeated medical evaluation due to persistence or worsening of initial symptoms during a 10-day follow-up period. Results: Respiratory tract infections were the most common (50%) followed by urinary tract infections (17.6%), sepsis of unknown origin (4.9%) and other infections (27.5%). PSP exhibited intermediate performance in predicting short-term adverse outcomes with an AUC of 0.734 (p < 0.001). In contrast, other inflammatory biomarkers such as procalcitonin, C-reactive protein (CRP) and White Blood Cells (WBCs) did not predict adverse outcomes (procalcitonin: AUC 0.680, p = 0.059; CRP: AUC 0.593, p = 0.072; WBC: AUC 0.635, p = 0.074). Conclusions: PSP appears to be a promising biomarker reflecting the severity of infection. Point-of-care PSP evaluation may serve as an early predictor of adverse events in patients presenting with infection to the ED. Full article

This study examines the evolution of container throughput and competitive market-share dynamics in the three principal Baltic container ports—Klaipeda, Riga, and Tallinn—during the period 2005–2024 and provides baseline forecasts to 2030. The proposed analytical framework combines descriptive statistical analysis, normalized market-share assessment, growth-rate analysis, and ordinary least-squares trend estimation with prediction intervals to distinguish aggregate market fluctuations from port-specific competitive realignments. The results indicate increasing market concentration in Klaipeda, a gradual decline in Riga’s relative position, and long-term stagnation and volatility in Tallinn. Common regional shocks are observed during the 2009 global financial crisis and the COVID-19 disruption in 2020, while atypical positive deviations in Klaipeda suggest competitive redistribution effects associated with changes in regional logistics flows and shipping-network configurations. Forecast results indicate continued medium-term growth in Klaipeda and Riga, whereas Tallinn demonstrates weaker trend stability and greater forecast uncertainty. The study contributes a transparent and reproducible baseline decision-support framework that can be implemented using routinely available throughput statistics for medium-term infrastructure assessment and capacity evaluation, infrastructure prioritisation, and risk monitoring. The findings also highlight the limitations of deterministic linear forecasting in volatile port systems and support future integration with higher-frequency operational data and machine-learning forecasting approaches. Full article

This paper aims to develop an on-board shock absorber detection method for general aviation aircraft. The effects of common gas and oleo leakage are analyzed in this paper. Based on the principle of landing gear dynamics, it is found that gas leakage and oleo leakage would mainly affect air spring force of shock absorbers in various ways. A rigid–flexible coupled landing gear multi-body system (MBS) model is developed by considering strut flexibility, aiming to offer more accurate simulated responses. A database is developed that considers common leakage faults and typical landing conditions using the developed landing gear model. A deep learning model is proposed in this paper. The proposed model is trained and tested using the database simulated from the rigid–flexible coupling landing gear model. The proposed method demonstrates robust detection performance, achieving over 95% precision for most fault types. This work provides a practical, sensor-efficient solution for real-time health monitoring of landing gear shock absorbers, contributing to improved maintenance strategies and operational safety for general aviation aircraft. As this is a preliminary feasibility study, full validation requires future drop tests or instrumented flight tests. Full article

This study examines whether endogenous inter-firm volatility spillovers amplify industry risk in China’s new energy sector. It constructs a leave-one-out industry index under a market–industry two-factor framework, extracts residual stock returns, and estimates firm-level residual conditional volatility. Based on these volatility series, the LASSO-VAR connectedness approach is employed to identify the direction, magnitude, and structure of firm-specific volatility spillovers across firms. Total spillovers, total within-group spillovers, and total between-group spillovers are then separately introduced into a GARCH-X model to test whether inter-firm risk transmission net of common factor exposures is associated with elevated industry conditional volatility. The results show that, even after removing market-wide and industry-wide common factors, firm-level residual volatilities remain widely and significantly interconnected. These spillovers exhibit clear time-varying characteristics and become markedly stronger around 2024. The GARCH-X results further indicate that all three spillover measures are positively and significantly associated with industry volatility, and that the amplifying effect of within-group spillovers is at least as strong as that of between-group spillovers. The findings suggest that industry risk is driven not only by external shocks, but also by amplification mechanisms operating within the inter-firm network that are not captured by common factor models alone. Full article

Amid intensifying climate crises, widening inequalities, and geopolitical volatility, spatial economic resilience (SER) has become critical for regions facing systemic uncertainty. Traditional land-intensive productivity models prove increasingly untenable as spatial resources become finite and development space constrained. China’s new quality productivity (NQP) has emerged as a strategic response emphasizing innovation-driven structural renewal and territorial coordination. Conceptually, NQP is positioned as a SER-oriented strategy prioritizing adaptability, recoverability, and transformability. However, its actual associations remains theoretically overlooked and empirically untested, with existing research viewing it narrowly as technological upgrading while neglecting institutional dimensions, spatial dependencies, and multi-scalar heterogeneities. This study explores how NQP relates to SER from a spatio-temporal perspective: (1) How do the technological and institutional dimensions of NQP relate to SER? (2) What are the spatial patterns of NQP-SER associations across multi-scale locations? Employing XGBoost-SHAP, spatial generalized difference-in-differences, and Geographical Gaussian Process Regression across provincial, city, and enterprise scales in China, we find that NQP’s two dimensions relate to SER very differently. The technological–industrial dimension is the strongest predictor of SER at the provincial scale, exhibiting threshold-type, non-linear associations, while its predictive salience attenuates at the city and enterprise scales, where industrial structure and firm-specific fundamentals are more strongly associated with resilience. The institutional dimension, by contrast, is not positively associated with above-expectation resilience: once common shocks and provincial heterogeneity are absorbed, higher institutional policy intensity is negatively associated with SER, both within provinces and across neighbouring provinces. Spatially, provincial associations rely on coordination and interregional spillovers, while city associations concentrate in nodal clusters where the strength of association depends on capability–context alignment. The findings provide practical theoretical and analytical guidance for tailored policy-making in structurally diverse Global South facing ongoing uncertainty. Full article

Cold stress poses a significant challenge to aquatic organisms, affecting their survival, growth, and metabolic processes. This review explores the molecular mechanisms by which fish, crustaceans, and mollusks respond to cold stress, highlighting the shared and species-specific pathways that facilitate adaptation. Common responses to cold stress include modulation of energy metabolism, regulation of oxidative stress, immune responses, and maintenance of proteostasis. In particular, the activation of the adenosine 5′-monophosphate-activated protein kinase (AMPK) and mechanistic target of rapamycin (mTOR) pathways plays a critical role in regulating energy balance and autophagy in response to low temperatures. Furthermore, we examine the specific adaptive mechanisms employed by different groups of aquatic organisms. Fish utilize pathways such as peroxisome proliferator-activated receptor alpha/peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PPAR/PGC-1α) and fatty acid oxidation to optimize energy utilization and improve cold tolerance. Crustaceans rely on crustacean hyperglycemic hormone (CHH) signaling and AMPK pathway activation, while mollusks employ metabolic suppression and glycogen storage to survive cold exposure. Moreover, the regulation of autophagy and apoptosis, mediated by p53 and cyclin-dependent kinase 1 (Cdk1), ensures the survival of healthy cells under prolonged cold stress, with autophagy maintaining energy homeostasis and apoptosis eliminating damaged cells. This review also discusses the role of molecular chaperones like heat shock protein 70 (HSP70) and the ubiquitin-proteasome system (UPS) in protein homeostasis, highlighting their importance to protect cells under cold stress. The combined action of these molecular pathways allows aquatic organisms to cope with and adapt to cold environments, ensuring cellular integrity and enhancing survival. Future research should focus on integrating molecular, physiological, and ecological approaches to better understand cold tolerance mechanisms and improve aquaculture practices under climate change scenarios. Full article