Search Results (6,629)

Urban lakes are essential for ecological balance and urban development. This study developed a comprehensive framework to evaluate the ecosystem health of urban lakes in China. Nineteen representative lakes from four lake zones were examined using three decades of remote-sensing data combined with hydrological, water-quality, and aquatic–biological investigations. An extended DPSIR model guided the selection of 52 indicators, and a hierarchical weighting scheme was used: the analytic hierarchy process determined criterion-level weights, while principal component analysis with Softmax normalization was used for indicator-level weights. The established index system was applied to Xuanwu Lake and Erhai Lake, and an obstacle-degree model was used to identify key ecological constraints from 2010 to 2020. Results showed that urban lakes in the Yunnan–Guizhou Plateau and Eastern Plain zones were mainly constrained by eutrophication and intensive urbanization, with state- and impact-related indicators contributing most to the health index. The framework captured the decline of Xuanwu Lake, driven by poor water exchange and external nutrient loading, and its subsequent improvement following governance interventions, as well as the post-2014 degradation of Erhai Lake driven by climate-induced hydrological stress and non-point source pollution, providing a practical tool for diagnosing constraints and supporting adaptive, region-specific lake management. Full article

Salt-sensitive hypertension (SSH) is an important and common subtype of hypertension, whose pathogenesis involves multi-level regulation, including the central nervous system (CNS), metabolic stress, and epigenetics. Dietary bioactive compounds have emerged as a research hotspot for SSH intervention due to their safety and multi-target effects. Although existing studies have focused on the CNS regulation of SSH or the role of individual dietary components, there is a lack of comprehensive analysis integrating multiple mechanisms, systematically summarizing multiple compounds, and incorporating a clinical translation perspective. This review first outlines the mechanisms of CNS pathways, endoplasmic reticulum (ER) stress, mitochondrial dysfunction, and epigenetic modifications in SSH. Then, it systematically reviews the mechanisms of action and preclinical and clinical research progress of bioactive compounds, including capsaicin, taurine, gamma-aminobutyric acid, tea, and anthocyanins in SSH. In summary, this review systematically clarifies the complex regulatory network of SSH and the intervention potential of dietary bioactive compounds from an integrated perspective, innovatively proposes a precise dietary intervention framework, and fills the research gaps in the integration of multiple mechanisms and systematic evaluation of compounds in existing studies. This framework not only provides a new integrated perspective for the basic research of SSH but also offers key references for clinical dietary guidance, functional food development, and the formulation of targeted intervention strategies. Full article

Balancing tourism industry (TI) growth and ecological protection is critical for sustainable development in the Yellow River Basin (YRB), China’s vital ecological security barrier and economic belt. However, existing research lacks a spatial perspective on the coordinated development between TI and inclusive green growth (IGG), with limited understanding of cross-regional spillover mechanisms. Based on panel data from 75 cities in the YRB (2011–2023), this study constructs a comprehensive evaluation system encompassing the scale, structure, and potential dimensions of the TI and the economic, social, livelihood, and environmental dimensions of IGG. The study employs the coupling coordination degree (CCD) model, exploratory spatial data analysis (ESDA), and the Spatial Durbin Model (SDM) to examine spatiotemporal evolution and spillover effects. The results reveal an upward yet fluctuating coordination trend with pronounced spatial heterogeneity, characterized by a “downstream–midstream–upstream” gradient pattern, dual-core radiation centered on the Jinan–Qingdao and Xi’an–Zhengzhou agglomerations, and persistent High–High clusters in the Shandong Peninsula contrasted with Low–Low clusters in the upstream Qinghai–Gansu–Ningxia region. Critically, new-quality productive forces exert significant positive direct and spillover effects, while industrial structure and government intervention have inhibitory spatial effects on adjacent cities. Regional heterogeneity analysis confirms factor-endowment-driven differentiation across upstream, midstream, and downstream areas. These findings advance spatial spillover theory in river basin contexts and provide evidence-based pathways for balancing economic growth with ecological protection in ecologically sensitive regions worldwide, directly supporting multiple UN Sustainable Development Goals. Full article

Background: Head and neck cancer patients frequently encounter nutritional deterioration, culminating in poor clinical and treatment-related outcomes and reduced quality of life. This systematic review and meta-analysis aim to examine the effects of non-invasive nutritional interventions on nutritional status and clinical, biochemical, and patient-reported outcomes. Methods: A comprehensive literature search across five databases (PubMed, CINAHL, ProQuest, Medline, and Scopus) was carried out to identify potentially relevant randomized control trials published in English between 2019 and 2024. Screening, extraction of data, and quality check were carried out separately by two reviewers. The Joanna Briggs Critical Appraisal tools assessed the quality of the included studies and evidence certainty was appraised using the GRADE framework. Depending on the amount of heterogeneity present, a random or fixed-effects model was used to conduct the meta-analysis. Results: Eleven studies were included, involving 1000 participants. Pooled estimates showed significant effects on weight (SMD = 0.171, 95%CI: 0.008, 0.335, p = 0.04), serum albumin (SMD = 0.539, 95%CI: 0.150, 0.927, p= 0.007), and patient-generated subjective global assessment score (SMD = −0.518, 95%CI: −0.931, −0.106, p = 0.014) in the intervention group compared to controls. Bias concerns were observed in some studies, largely stemming from inadequate blinding and deviations from intention-to-treat analysis. Evidence certainty ranged from moderate to very low. Conclusions: Non-invasive, patient-directed nutritional interventions may lead to clinically meaningful benefits in patients with head and neck cancer receiving chemoradiotherapy, particularly for the maintenance of body weight and nutritional status. However, robust, adequately powered trials with standardized reporting of intervention components and outcome measures are needed in the future to strengthen the evidence base for clinical application. Full article

Bovine ketosis represents a critical metabolic challenge in modern dairy production, primarily affecting high-yielding cows during the periparturient period. The disorder arises from severe negative energy balance (NEB), where energy demands exceed supply, triggering substantial mobilization of adipose tissue and hepatic accumulation of non-esterified fatty acids (NEFAs). This stress overwhelms hepatic oxidative capacity, leading to incomplete fatty acid oxidation and excessive ketone body production—primarily β-hydroxybutyrate (BHB), acetoacetate, and acetone. While genomics enables the identification of candidate genes and genetic variations influencing ketosis susceptibility, metabolomics provides comprehensive, multi-matrix metabolic signatures across blood, milk, urine, and tissues, often revealing predictive biomarkers in the dry period and pre-clinical stage. This review provides a comprehensive overview of ketosis etiology, emphasizing the roles of NEB, fat mobilization, hormonal dysregulation, and oxidative stress. We systematically examine candidate genes, signaling pathways, and the diverse metabolomic profiles underlying disease pathogenesis, and discuss current prevention strategies focusing on periparturient nutritional management and therapeutic interventions. Understanding these integrated molecular and metabolic mechanisms offers valuable insights for developing targeted breeding programs and precision management approaches to enhance metabolic health and economic efficiency in dairy cattle. Full article

Background: The present study aimed to identify the differences between experiences, in terms of oral health-related quality of life, pain, side effects and/or other complications, of adults undergoing orthodontic treatment using removable aligners and fixed labial or lingual appliances. Methods: The review was registered with PROSPERO, and a comprehensive electronic search was undertaken without language or date restrictions. Randomised and non-randomised trials and prospective cohort and cross-sectional studies along with case series were included. The Cochrane Collaboration’s Risk of Bias 2 Tool, Newcastle–Ottawa Scale and The Risk Of Bias In Non-Randomized Studies—of Interventions tools were used to assess quality. Data were grouped in terms of oral health-related quality of life, pain side effects and/or other complications. Results: Data from 35 studies were included; 9 were eligible for meta-analysis. Thus 2611 participants were included related to removable aligners (n = 513), fixed labial (n = 1816) and lingual (n = 218) appliances or a combination (n = 64) of appliances. The standardised mean differences in visual analogue scale pain reports between 24 h and 7 days were −10.02 (95% CI: −11.13, −8.91) for aligners and −6.40 (95%CI: −10.42, −2.38) for labial appliances (p = 0.09). There was a significant improvement in dental self-confidence following fixed labial appliance treatment (p = 0.001). Conclusions: No difference was detected in short-term pain with aligners and labial appliances. Aligners may have less impact on oral health-related quality of life measures compared to labial appliances. Lingual appliances have a persistent impact on speech, despite some adaptability. Any deterioration in oral health-related quality of life measures during treatment appears temporary. Further randomised trials using validated assessment tools and comparing aligners and labial and lingual appliances are required. Full article

Background/Objectives: Single-sided deafness (SSD) treatment options include Contralateral Routing of Signal (CROS) or Bilateral Routing of Signal (BiCROS) systems, bone conduction devices, cochlear implants (CIs) and no intervention. Aligning treatment recommendations with patient motivations is fundamental for satisfaction and successful outcomes. At our institution, a structured telehealth consultation precedes formal testing and includes treatment motivation exploration and comprehensive review of all interventions. This study examined SSD treatment motivations and their association with pursuing cochlear implantation. Methods: Adults who completed a pre-treatment SSD telehealth consultation over a four-year period were identified. Charts were retrospectively reviewed for demographics, SSD characteristics, treatment motivations, treatment choice, and CI outcomes. Results: A total of 122 adults were evaluated. Mean age was 56.3 (±13.0) years, and 59.8% were male. Mean SSD duration was 10.8 (±15.8) years. The most common etiology was sudden sensorineural hearing loss. The top primary motivations were improving overall hearing (23.0%), restoring hearing to the deaf ear (22.1%), and improving hearing in noise (21.3%). Most patients (45.1%) opted for a hearing aid, CROS or BiCROS system; 38.5% chose CI; and 14.8% declined treatment. Only 57.4% of those who selected CI had the implant, primarily due to surgery avoidance (31.5%) and insurance limitations (10.5%). Motivation did not predict treatment choice or CI receipt. Among CI recipients (n = 27), those motivated by hearing restoration demonstrated poorer speech outcomes and datalogging. Conclusions: Improving overall hearing and restoring hearing to the deaf ear were the most common motivations for seeking SSD treatment. Adult CI recipients had similar motivations to those who chose non-surgical options. Full article

Background/Objectives: Benign bone tumors and tumor-like conditions are commonly encountered in the pediatric population, often discovered incidentally during radiographic evaluation or presenting with symptoms such as pain, swelling, or pathologic fractures. Despite their benign nature, these lesions can significantly impact bone integrity and function. The objective of this study was to characterize the epidemiology, histopathological spectrum and management of benign bone tumors in a pediatric population. Methods: We conducted a retrospective observational single-center study of pediatric patients diagnosed with benign bone tumors or tumor-like lesions between 2013 and 2023. Clinical presentations, radiological findings, histopathological diagnoses, and treatment modalities were reviewed. Biopsy results and surgical indications were analyzed to assess diagnostic yield and therapeutic strategies. Results: Among the 253 biopsies performed, 220 cases (86.6%) were diagnosed as benign tumors, with osteochondromas being the most common (62.3%). The majority of cases involved the appendicular skeleton, with a male predominance. Simple bone cysts, aneurysmal bone cysts, and nonossifying fibromas were also frequently observed. Pathological fractures were documented in 5.45% of cases. Surgical intervention was indicated in patients with symptomatic lesions, pathological fractures, or radiological signs of structural instability. Conclusions: Benign bone tumors and tumor-like lesions in pediatric patients, although non-malignant, may lead to significant skeletal complications. Our findings highlight the importance of structured diagnostic evaluation and individualized treatment planning based on lesion type, location and clinical presentation. Early radiological assessment combined with histopathological confirmation plays a key role in preventing complications and optimizing outcomes. A multidisciplinary approach remains essential in the comprehensive management of these conditions. Full article

Background: Heart failure with reduced ejection fraction (HFrEF) markedly impairs quality of life (QoL) and life expectancy. The main therapeutic goals are to reduce mortality, improve functional capacity, and enhance QoL. Exercise training is an evidence-based, non-pharmacological component of standard care that improves functional capacity and clinical outcomes in HFrEF. This review examines the effects of endurance and resistance training on peak oxygen uptake (VO₂peak), ventilatory efficiency (VE/VCO₂ slope), health-related QoL, and cardiovascular outcomes in patients with HFrEF. Methods: A structured narrative review was conducted using comprehensive searches of PubMed, EMBASE, and the Cochrane Library for English-language studies published between January 2004 and October 2024. Eligible studies included adult HFrEF populations undergoing aerobic and/or resistance training with reported effects on VO₂peak, ventilatory efficiency, QoL, or clinical outcomes. Given the heterogeneity of interventions, comparators, and outcome metrics, data were synthesized descriptively. Results: Across 18 studies (plus one sub-analysis) including 3401 patients, 17 trials assessed VO₂peak and 16 reported significant improvements, with an average increase of approximately 2 mL·kg⁻¹·min⁻¹. Six studies assessed ventilatory efficiency, and five demonstrated reductions in VE/VCO₂ slope averaging 4.4 units. Eleven studies analyzed QoL, and nine reported significant improvements corresponding to an ≈5-point decrease in the Minnesota Living with Heart Failure Questionnaire (MLHFQ). In the largest trial, exercise training was associated with modest but statistically significant reductions in all-cause mortality or hospitalization (HR 0.89) and cardiovascular mortality or heart-failure hospitalization (HR 0.85) after adjustment for baseline prognostic factors. Conclusions: Structured exercise training improves aerobic capacity, ventilatory efficiency, and QoL in patients with HFrEF, with supportive evidence for reduced morbidity and mortality. These findings underscore the value of structured exercise as a core component of modern HFrEF management. Full article

Background/Objectives: Acute respiratory distress syndrome (ARDS) represents a critical complication in polytrauma patients, characterized by diffuse lung inflammation and bilateral pulmonary infiltrates with mortality rates reaching 45% in intensive care units (ICU). The heterogeneous nature of ARDS and complex clinical presentation in severely injured patients poses substantial diagnostic challenges, necessitating early prediction tools to guide timely interventions. Machine learning (ML) algorithms have emerged as promising approaches for clinical decision support, demonstrating superior performance compared to traditional scoring systems in capturing complex patterns within high-dimensional medical data. Based on the identified research gaps in early ARDS prediction for polytrauma populations, our study aimed to: (i) develop a balanced random forest (BRF) ML model for early ARDS prediction in critically ill polytrauma patients, (ii) identify the most predictive clinical features using ANOVA-based feature selection, and (iii) evaluate model performance using comprehensive metrics addressing class imbalance challenges. Methods: This retrospective cohort study analyzed 407 polytrauma patients admitted to the ICU of the Center of Traumatology and Major Burns of Ben Arous, Tunisia, between 2017 and 2021. We implemented a comprehensive ML pipeline that incorporates Tomek Links undersampling, ANOVA F-test feature selection for the top 10 predictive variables, and SMOTE oversampling with a conservative sampling rate of 0.3. The BRF classifier was trained with class weighting and evaluated using stratified 5-fold cross-validation. Performance metrics included AUROC, PR-AUC, sensitivity, specificity, F1-score, and Matthews correlation coefficient. Results: Among 407 patients, 43 developed ARDS according to the Berlin definition, representing a 10.57% incidence. The BRF model demonstrated exceptional predictive performance with an AUROC of 0.98, a sensitivity of 0.91, a specificity of 0.80, an F1-score of 0.84, and an MCC of 0.70. Precision–recall AUC reached 0.86, demonstrating robust performance despite class imbalance. During stratified cross-validation, AUROC values ranged from 0.93 to 0.99 across folds, indicating consistent model stability. The top 10 selected features included procalcitonin, PaO₂ at ICU admission, 24-h pH, massive transfusion, total fluid resuscitation, presence of pneumothorax, alveolar hemorrhage, pulmonary contusion, hemothorax, and flail chest injury. Conclusions: Our BRF model provides a robust, clinically applicable tool for early prediction of ARDS in polytrauma patients using readily available clinical parameters. The comprehensive two-step resampling approach, combined with ANOVA-based feature selection, successfully addressed class imbalance while maintaining high predictive accuracy. These findings support integrating ML approaches into critical care decision-making to improve patient outcomes and resource allocation. External validation in diverse populations remains essential for confirming generalizability and clinical implementation. Full article

Background/Objectives: Sleep health impacts numerous domains of human health, and sleep deprivation has emerged as a significant public health concern. Multiple types of dietary nutrient supplementation, dietary intake, and the use of nutritional supplements to enhance sleep quality are recognized as effective methods to improve sleep quality. Methods: We aim to systematically evaluate the efficacy of dietary supplement interventions in sleep quality improvement across populations with sleep disorders and healthy individuals. We conducted a comprehensive literature search across PubMed, Web of Science, CNKI, ScienceDirect, Wiley, and CVIP databases. Sleep evaluation metrics included the Pittsburgh Sleep Quality Index (PSQI), sleep efficiency (SE), sleep latency (SL), total sleep time (TST), wake after sleep onset (WASO), and number of awake after sleep onset (NASO). Meta-analysis procedures were executed in Review Manager 5.3 and Stata 17.0, with heterogeneity quantified via I² statistics. Results: This study, in total, included 28 randomized controlled trials. This meta-analysis’s results suggest dietary interventions significantly improved sleep outcomes: reduced PSQI (MD: −0.70, 95% CI: −1.37 to −0.03, p < 0.05), increased SE (+2.58 min, 95% CI: 2.01–3.16, p < 0.00001), prolonged TST (SMD: +0.23, 95% CI: 0.04–0.43, p < 0.05), and shortened SL (SMD: −0.24, 95% CI: −0.37 to −0.10) and WASO (SMD: −0.30, 95% CI: −0.48 to −0.12) (both p < 0.001). NASO showed a marginal reduction (MD: −1.57, 95% CI: −3.16 to 0.02, p = 0.05). Conclusions: These findings suggest that tryptophan, vitamin D, omega-3, zinc, and antioxidants may enhance sleep quality by decreasing SL, and WASO increases SE and extends TST, respectively. Full article

Neuroendocrine neoplasms (NENs) are rare and heterogeneous tumors with heterogeneity in morphology and molecular profile and consequently resulting in a heterogeneous biological behavior. They have a more indolent natural history compared to the classic cancer and may emerge in any site of the human body, but usually they have gastroenteropancreatic (GEP) or bronchopulmonary (BP) origin. When NENs are well differentiated, they are called neuroendocrine tumors (NETs) as opposed to poorly differentiated neuroendocrine carcinomas (NECs). They may secrete a bioactive molecule resulting in a secretory syndrome or they may not be associated with any secretory product, defining functional and non-functional NENs. The hormonal hypersecretion syndromes, the chronic symptom burden, the tumor-related inflammation, and the treatment side effects impair nutritional intake and absorption while increasing metabolic needs. The present comprehensive narrative review is summarizing established and emerging methods of nutritional and body composition assessment, and the recent evidence of interventions for sarcopenia and malnutrition in patients with NETs. Early identification and management of malnutrition and sarcopenia are fundamental steps to improve quality of life and clinical outcomes in these patients during the long natural history of these neoplasms. Full article

The United Kingdom’s (UK) retrofit revolution is at a crossroads and the efficacy of retrofit interventions is not solely a function of insulation thickness. To truly slash emissions and lift households out of fuel poverty, we must solve the persistent problem of thermal bridging (TB), i.e., the hidden flaws that cause heat to escape, dampness to form, and well-intentioned retrofits to fail. This review moves beyond basic principles to spotlight the emerging tools and transformative strategies to make a difference. We explore the role of advanced modelling techniques, including finite element analysis (FEA), in pinpointing thermal and moisture-related risks, and how emerging materials like vacuum-insulated panels (VIPs) offer high-performance solutions in tight spaces. Crucially, we demonstrate how an integrated fabric-first approach, guided by standards like PAS 2035, is essential to manage moisture, ensure durability, and deliver the comfortable, low-energy homes the UK desperately needs. Therefore, achieving net-zero targets is critically dependent on the systematic upgrade of the building envelope, with the mitigation of TB representing a fundamental prerequisite. The EnerPHit approach applies a rigorous fabric-first methodology to eliminate TB and significantly reduce the building’s overall heat demand. This reduction enables the use of a compact heating system that can be efficiently powered by renewable energy sources, such as solar photovoltaic (PV). Moreover, this review employs a systematic literature synthesis to critically evaluate the integration of TB mitigation within the PAS 2035 framework, identifying key technical interdependencies and research gaps in whole-house retrofit methodology. This article provides a comprehensive review of established FEA modelling methodologies, rather than presenting results from original simulations. Full article

Background and Objectives: IgA nephropathy represents the most prevalent form of primary glomerulonephritis around the world, with significant heterogeneity in management strategies and outcomes. We conducted a systematic review and meta-analysis to evaluate the efficacy and safety of pharmacological interventions for IgA nephropathy. Materials and Methods: We searched multiple databases through June 2025, identifying randomized controlled trials and observational studies evaluating pharmacological treatments in biopsy-proven IgA nephropathy. Primary outcomes included proteinuria reduction and estimated glomerular filtration ration (eGFR) preservation. Secondary outcomes included hard kidney endpoints and safety parameters. Random-effects meta-analyses were performed with comprehensive risk–benefit assessments. Results: Twenty-five studies were included. B-cell/plasma-cell-targeted therapies showed significant proteinuria reduction (−34.0% [95% CI: −45.7, −22.3%]), complement pathway inhibitors demonstrated superior eGFR preservation (+5.8 mL/min/1.73 m²/year [95% CI: 2.4, 9.2]). Systemic corticosteroids showed observed hard outcome benefits (HR 0.37 [95% CI: 0.26, 0.52]) but highest adverse event risk (RR 3.28 [95% CI: 2.11, 5.09]). Novel agents showed projected favorable effects (B-cell: HR 0.38; complement: HR 0.42) pending validation. Conclusions: Novel targeted therapies, especially B-cell/plasma-cell-targeted agents and complement pathway inhibitors, show promising risk–benefit profiles. However, longer-term data and standardized eGFR slope reporting are needed to confirm these findings compared to other immunosuppressive agents. Full article

Cellular senescence is defined as a state of permanent cell cycle arrest, providing a natural barrier against cancer. However, senescent cells are very metabolically active and secrete a complex mixture of bioactive molecules collectively known as the senescence-associated secretory phenotype (SASP), which play a dual role in cancer biology. While the SASP can suppress tumors by facilitating immunosurveillance, it can also promote tumor progression by fostering a pro-inflammatory milieu, stimulating angiogenesis, enhancing invasiveness, and enabling immune evasion. In Head and Neck Cancers (HNCs), a highly heterogeneous group of malignancies, SASP has emerged as a critical player in disease progression and treatment resistance. Persistent DNA damage response (DDR) signaling drives SASP and thereby contributes to the progression of head and neck cancer by modulating the tumour microenvironment. It influences the tumor microenvironment (TME) by facilitating epithelial-to-mesenchymal transition (EMT), promoting cancer stem cell-like properties, and impairing the efficacy of radiotherapy, chemotherapy, and immune checkpoint inhibitors. These effects underscore the need for targeted interventions to regulate SASP activity. This review presents a comprehensive overview of the molecular mechanisms underlying SASP generation and its effects on HNCs. We discuss the dual roles of SASP in tumor suppression and progression, its contribution to therapy resistance, and emerging therapeutic strategies, including novel senolytic and senomorphic drugs. Finally, we highlight key challenges and future directions for translating SASP-targeted therapies into clinical practice, emphasizing the need for biomarker discovery, and a deeper understanding of SASP heterogeneity. By targeting the SASP, there is potential to enhance therapeutic outcomes and improve the management of HNCs. Full article