Search Results (222)

Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory disease predominantly of the small airways and parenchyma. COPD lungs exhibit an influx of circulating innate immune cells, which, when isolated, display impaired functions, including imbalanced protease secretion. In addition to immune cells, the extracellular matrix (ECM) plays a crucial role in COPD pathology. Remodeling of the ECM can generate ECM fragments, which can be released into circulation and subsequently induce pro-inflammatory responses. COPD is a heterogeneous disease, and serological biomarkers can be used to sub-categorize COPD patients for targeted treatments and optimal recruitment in clinical trials. This study evaluated fragments of calprotectin, collagen type VI, and versican, generated by neutrophil elastase and matrix metalloproteinases (MMP-) 2 and 12, respectively, as potential biomarkers of COPD disease, severity, and endotypes. Lower plasma levels of a neoepitope marker of calprotectin, indicative of activated neutrophils (nordicCPa9-HNETM), were detected in COPD donors compared to controls. CPa9-HNE was associated with milder disease, higher degree of air-trapping, and higher serum levels of MMP-2. Deposition of CPa9-HNE levels in lung tissue revealed no differences between groups. Taken together, CPa9-HNE was found to be a potential marker of mild COPD, but further studies are warranted to validate our findings. Full article

Against the background of intensifying human–land contradictions, evaluation of land use benefits and identification of obstacles are crucial for sustainable land management and socioeconomic development. Taking Henan Province as an example, this research employed the entropy weight method and TOPSIS model to assess the land use benefits across its cities from 2011 to 2020, a period of rapid land use transformation, analyzed their spatiotemporal evolution, and identified key obstacles via an obstacle degree model. The results showed the following. (1) The social land use benefits consistently exceeded the ecological and economic benefits, with steady improvements observed in both the individual and comprehensive benefits. Spatially, the benefits showed a “one city dominant” pattern, decreasing gradually from the central region to the south, north, east, and west, with this spatial gradient further intensifying over time. (2) Economic factors were the primary obstacles, with significantly higher obstruction degrees than social or ecological factors. The main obstacles were the general budget revenue of government finance per unit land area, domestic garbage removal volume, and total retail sales of social consumer goods per unit land area. (3) The policy implications focus on strengthening regional differentiated development by leveraging Zhengzhou’s core role to boost the land-based economic benefits, integrating social–ecological strengths with agricultural modernization, and promoting “core–periphery linkage” to narrow gaps through targeted industrial and infrastructure strategies. This study could provide region-specific insights for sustainable land management in agricultural provinces undergoing rapid urbanization. Full article

Background/Objectives: Tl-201 myocardial perfusion single-photon emission computed tomography (MPS) is a minimally invasive test for patients with suspected coronary artery disease (CAD). While its predictive and prognostic values are well established, diagnostic performance varies. A recent meta-analysis reported that the sensitivity and specificity of MPS range from 48.8 to 100% and 46.7 to 94.7%, respectively, reflecting discordance between CAG. Little is known, however, about the influence of patients’ characteristics and CAD risk factors on the diagnostic performance of MPS. This study aims to evaluate these factors in relation to MPS performance. Methods: We screened 4817 consecutive patients referred to our Nuclear Medicine Department in 2015 for Tl-201 MPS. Patients with clinically suspected ischemic heart disease who underwent CAG within 60 days post-MPS were included in the present analysis. The percentage of agreement/disagreement between the MPS-abnormal/normal and CAG-positive/negative groups was evaluated. Additionally, patient characteristics, CAD risk factors, co-morbidities, and single-photon emission computed tomography (SPECT) image-derived parameters were compared among the patients. Results: Among 635 patients with abnormal MPS, 583 had coronary stenosis. For the 52 without stenosis, causes included non-obstructive CAD (34.6%), prior infarction with scarring (32.7%), and imaging artifacts (32.7%). Significant stenosis was associated with older age, male sex, diabetes, dyslipidemia, CKD, and prior PCI, while hypertension and higher BMI were more common in insignificant CAD. Among 104 patients with normal MPS, 79 had stenosis, mainly in the LAD. Clinical risk factors were more prevalent in patients with any degree of stenosis. Conclusions: In patients with an abnormal MPS, the incorporation of visual interpretation, parameters, and CAD risk factors increases specificity and helps differentiate obstructive from non-obstructive CAD. Full article

We are living in a world filled with artifacts, including daily-use and durable products. In the context of sustainable consumption and production (SCP), the term “sufficiency” is an essential keyword. The concept of sufficiency is important for grasping the overall contribution of product functions to the fulfillment of human needs in terms of social sustainability. Sufficiency is also understood to be a necessary component for reducing the environmental impact of daily-use and durable products on the natural environment. Therefore, sufficiency is regarded as a key factor in promoting environmental sustainability. Generally, a product itself is not as essential as the functions it provides to the user. However, product functions have not only positive aspects that satisfy human needs, but also negative aspects that do not. Most existing methods for assessing the satisfaction of human needs are based on direct approaches, such as life satisfaction surveys, which do not take product functions into account. In the previous study, we proposed a living-sphere approach that integrates the traditional engineering design framework with Max-Neef’s framework of needs, relating product functions to fundamental human needs. In Max-Neef’s framework, a key concept is the “satisfier,” which refers to a conceptual method of satisfying universal human needs; however, this concept varies according to regional or local circumstances, such as culture, climate, and history. This study proposes a method to evaluate net sufficiency, which is the overall impact of product functions, both positive and negative, on fulfilling fundamental human needs. Through introducing not only a satisfier that fulfills but also a barrier that obstructs fundamental human needs, it is possible to comprehensively evaluate the degree to which a product’s functions fulfill such needs. Two case studies from Osaka and Hanoi were carried out independently, showing that the proposed method enables comprehensive evaluation of the net sufficiency of meeting fundamental needs in terms of the positive and negative aspects of product functions. Full article

Peripheral artery disease (PAD) is a chronic progressive accumulation of atherosclerotic lesions with varying degrees of arterial obstruction determining ischemic symptoms of the involved extremities. PAD is associated with decreased bioavailable nitric oxide due to endothelial cell dysfunction and the development and progression of vascular arterial stiffening (VAS). Atherosclerosis also plays an essential role in the development and progression of vascular arterial stiffening (VAS), which is associated with endothelial cell activation and dysfunction that results in a proinflammatory endothelium with a decreased ability to produce bioavailable nitric oxide (NO). NO is one of three gasotransmitters, along with carbon monoxide and hydrogen sulfide, that promotes vasodilation. NO plays a crucial role in the regulation of PAD, and a deficiency in its bioavailability is strongly linked to the development of atherosclerosis, VAS, and PAD. A decreased arterial patency may also occur due to a reduction in the elasticity or diameter of the vessel wall due to the progressive nature of VAS and atherosclerosis in PAD. Progressive atherosclerosis and VAS promote narrowing over time, which leads to impairment of vasorelaxation and extremity blood flow. This narrative review examines how atherosclerosis, aging and hypertension, metabolic syndrome and type 2 diabetes, tobacco smoking, and endothelial cell activation and dysfunction with decreased NO and VAS with its increased damaging pulsatile pulse pressure result in microvessel remodeling. Further, the role of ischemia and ischemia–reperfusion injury is discussed and how it contributes to ischemic skeletal muscle remodeling, ischemic neuropathy, and pain perception in PAD. Full article

Water resources are fundamental to sustaining life, fostering social development, and maintaining ecological balance. This study focuses on Anhui Province (AP) as the research area, employing 22 indicators from the Water-Socio-Ecological (WSE) framework for the water resource-water environment carrying capacity (WR-WECC) of AP. The WR-WECC of AP is assessed via differential evolution projection pursuit modeling (DE-PPM). Additionally, the degree of coupled coordination model (DCCM) is utilized to analyze the coordinated development among the municipalities of AP, whereas the obstacle degree model is employed to identify the primary obstacles affecting the enhancement of the WR-WECC and to forecast them via autoregressive composite moving averages. The findings of the study are as follows: (1) WR-WECC in AP showed a steady upward trend, and the water, socio-economic, and ecological subsystems showed a fluctuating upward trend, with ES increasing the fastest. The overall WR-WECC of each city shows a fluctuating upward trend, and the spatial gap narrows, with Southern Anhui (SA) > Central Anhui (CA) > Northern Anhui (NA). (2) The DCC of the WSE carrying capacity of AP also shows a fluctuating upward trend, gradually transitioning from barely coordinated to well coordinated. The DCC level of the WR-WECC in SA is better than that in CA and NA, and the growth rate is greater than that in CA and NA, whereas the DCC level in CA is better than that in NA, and the DCCs of the three major regions show an upward trend. (3) The degree of obstruction at the criterion level of AP’s WR-WECC basically maintains the following order: WS > SS > ES. In the indicator layer, the water supply modulus, water production modulus, and proportion of tertiary industry are the main obstacle factors restricting the enhancement of the WR-WECC of AP. (4) The prediction results for 2025–2040 indicated that the WR-WECC level and the three subsystem levels of AP showed a continuous increasing trend. Measuring WR-WECC plays a crucial role in regional sustainable development. Full article

As critical strategic mineral resources underpinning high-tech industries and national defense security, rare earth elements have become a central focus of international competition, with their global industrial chain configuration deeply intertwined with geopolitical dynamics. Leveraging a novel multilateral database encompassing 140 countries’ geopolitical relationships and rare earth trade flows (2001–2023), this study employs social network analysis and temporal exponential random graph models (TERGMs) to decode structural interdependencies across upstream mineral concentrates, midstream smelting, and downstream permanent magnet sectors. Empirical results show that topological density trajectories reveal intensified network coupling, with upstream/downstream sectors demonstrating strong clustering. Geopolitical cooperation and conflict exert differential impacts along the value chain: downstream trade exhibits heightened sensitivity to cooperative effects, whereas midstream trade suffers the most pronounced obstruction from conflicts. Cooperation fosters long-term trade relationships, whereas conflicts primarily impose short-term suppression. In addition, centrality metrics reveal asymmetric mechanisms. Each unit increase in cooperation degree centrality amplifies the mid/downstream trade by 3.29 times, whereas conflict centrality depresses the midstream trade by 4.76%. The eigenvector centrality of cooperation hub nations enhances the midstream trade probability by 5.37-fold per unit gain, in contrast with the 25.09% midstream trade erosion from conflict-prone nations’ centrality increments. These insights provide implications for mitigating geopolitical risks and achieving sustainable governance in key mineral resource supply chains. Full article

Background and Objectives: Individuals with chronic obstructive pulmonary disease (COPD) often exhibit some degree of intolerance to physical exercise and several limitations in daily activities. Therefore, the objective of this study was to conduct a scoping review on the characteristics—frequency, intensity, time, and type (FITT)—and the effects of exercise programs on quality of life and functional capacity in individuals with COPD. Materials and Methods: The present review included 21 studies that were scoping-reviewed to describe their main findings and training characteristics. Results: The participants across studies ranged in age from ~39 to 76 years with mild to very severe COPD stages. The results showed that, among all studies, eleven used cardiorespiratory training (e.g., walking or cycling), five used strength training (e.g., exercises with elastic bands or traditional resistance training), and five implemented combined training (i.e., cardiorespiratory and strength exercises). Conclusions: Overall, all training protocols improved aerobic capacity (cardiorespiratory training), strength (resistance training), and both capacities together (combined training). In conclusion, this review provided complementary insights to existing exercise prescription guidelines, particularly concerning cardiorespiratory, strength, and combined training in individuals with COPD. However, the methodologies of the training protocols varied widely, and detailed descriptions of FITT components were often incomplete or lacking clarity, especially regarding the specific exercises used. Future research should include more comprehensive spirometry variables such as forced expiratory volume 1 or forced vital capacity, as these are critical for determining COPD stages. Thus, there is a clear need for more high-quality research with robust methodological design in the context of exercise interventions for individuals with COPD. Full article

Background/Objectives: Postoperative hemorrhage is the most common complication after Trans-Oral Robotic Surgery (TORS) described in the literature. The aim of this study is to assess the presence of any risk factors that may impact postoperative bleeding. Methods: This was a retrospective study based on the analysis of patient data. Patients undergoing TORS procedures at the ENT Unit of Forlì Hospital from 2008 to 2022 for OSA (obstructive sleep apnea) or oncological disease and with a minimum follow-up of 30 days were included. The comorbidities analyzed were perioperative anticoagulant/antiplatelet therapy and clinicopathological features concerning the pathology. Total bleeding and severe bleeding (which required management in the operating room) were included. Results: A total of 414 patients (106 oncological TORS and 308 OSA TORS patients) were included. Post-TORS bleeding occurred in 47 cases (11.3%) and severe bleeding in 18 cases (4.3%). The pathology (oncology vs. OSA) treated with TORS did not represent a risk factor (p = 0.466). Antiplatelet intake represented an important risk factor (p = 0.002). Postoperative hemorrhage for oncological TORS occurred in 11.3% patients; of these, 6.6% had severe bleeding. Artery ligation during neck dissection prevented the risk of severe bleeding (p < 0.001). In TORS for OSA, postoperative hemorrhage was found in 11.4% cases, of which 3.6% were major bleeding. Neither the degree of OSA nor the association with other concurrent procedures were risk factors for postoperative bleeding in this study. Conclusions: Patients taking perioperative antiplatelet therapy have an almost 5-fold increased risk of developing postoperative bleeding. The pathology (oncology vs. OSA) does not influence the risk of bleeding. Prophylactic arterial ligation during neck dissection significantly decreases the risk of severe bleeding. Full article

Background/Objectives: This retrospective study used computer fluid dynamics (CFD) to evaluate the medium-term changes in the upper airways (UA) airflow after rapid maxillary expansion (RME) in three age-matched groups with different degrees of adenoidal obstruction. Methods: The sample included Cone-Beam Computed Tomography (CBCT) of 67 adolescents taken before (T0) and 12 months after RME (T1) and divided into three cohorts: Control Group (CG, <25% obstruction: 24 subjects, mean age = 11.8 ± 1.3), Adenoids Group 1 (AG1, >25% <75% obstruction: = 22 subjects, mean age = 10.9 ± 1.5), Adenoids Group 2 (AG2, >75% obstruction: = 21 subjects, mean age = 11.2 ± 1.6). The airflow pressure, velocity and obstruction were simulated using computer fluid dynamics (CFD). Results: The pressure significantly improved in CG and AG1 groups while the velocity improved in AG1 as well as the prevalence of obstruction improvement. The airflow pressure and velocity changes could be attributed to the reduction of the resistances in the adenotonsillar region, which was remarkably more marked in the AG1. Conclusions: Alterations in the adenotonsillar region likely represent the most substantial factors influencing airflow changes after RME. The integration of anatomical and functional data, along with the identification of baseline patient characteristics, may facilitate the characterization of phenotypes most appropriate for initial management through either Rapid Maxillary Expansion (RME) or otolaryngologic (ENT) interventions. Full article

The vulva is a complex anatomical organ that may present with a wide range of pathologies. Even if it can be easily investigated, correctly interpreting vulvar appearance is often challenging. Vulvar ultrasound is an emerging diagnostic technique that may be helpful in different aspects of vulvar pathology. We aimed to summarize the state of the art of vulvar ultrasound, provide the necessary theoretical bases of embryology and anatomy, describe the normal and pathological vulvar sonographic characteristics, and propose a feasible and reproducible methodology for vulvar ultrasound. Vulvar sonographic scan should be performed with a linear probe, preferably > 15 mHz, following a standardized methodology. The sonographic appearance of the normal vulva reflects the different histology of its structures and, thus, their embryogenetic origin. The description of a suspected vulvar lesion should include localization, dimensions, volume, type of growth, shape, appearance of the edges, depth of invasion, echogenicity, and identification of vascularization. Cystic dilatation of obstructed Bartolini ducts is the most common benign finding in the vulva (fluctuant structures in the posterior third of the labia majora containing clear mucous fluid). Malignant vulvar lesions appear as hypoechogenic or heterogeneous solid lesions with irregular margins and a high degree of vascularization. Extramammary Paget Disease presents a homogeneous hypoechogenic creeping area in the epidermis due to neoplastic cells typical of this disease. The potential applications of vulvar ultrasound are examining the content of a vulvar swelling to guide its management and assessing the response to medical treatment in the case of lichen sclerosus. In managing patients affected by vulvar malignancies, it may play a critical role in local staging, stromal invasion determination, measuring the distance from the midline, and assessing the eligibility for sentinel lymph node procedure. Vulvar ultrasound is a minimally invasive and economical test that can be performed with minimal equipment. Further studies will be necessary to validate the clinical applications, quantify the diagnostic performance, and evaluate the agreement between operators. Full article

Deep vein thrombosis (DVT) of the lower extremities, as part of venous thromboembolism disorder, is the third leading cause of acute cardiovascular syndrome after heart attack and stroke. It can result in disability due to pulmonary embolism (PE) and post-thrombotic syndrome (PTS), particularly in cases where the thrombosis extends to the iliofemoral veins. Anticoagulation therapy is effective in preventing thrombus propagation and embolism but may not be sufficient for thrombus degradation and venous patency restoration. Up to 50% of patients with iliofemoral DVT develop PTS, mainly due to venous outflow obstruction or valvular incompetence. To date, the advent of new devices that enables rapid thrombus elimination and the restoration of deep venous patency, known as the “OPEN VEIN hypothesis”, may prevent valvular damage and reflux, cutting down the rate of PTS. Similarly, chronic venous disease could be related to a stenosis or occlusion of a major vein that can restrict blood flow. In this setting, intravascular ultrasound (IVUS) is an essential tool for correct diagnostic and therapeutic planning in acute and chronic vein disease. Only angiography in vein disease can limit the procedure’s efficacy, with a high rate of stenosis misdiagnosed; IVUS provides further imaging that complements traditional angiographic study, and its role is now established by different international guidelines. If compared to angiography, IVUS allows for the evaluation of major axial veins in a 360-degree ultrasound image of the lumen and of the vessel wall structure. At the same time, the precise location and size of the major lower extremity veins allow for the placement of the stent to be more straightforward with a precise dimension of the vein in all of its diameters; moreover, other abnormalities should be visualized as acute or chronic thrombus, fibrosis, or trabeculations. This review aims to provide an in-depth analysis of IVUS findings in acute and chronic lower extremity DVT, emphasizing its diagnostic and therapeutic implications. Full article

Background: While severe exacerbations are known to worsen the prognosis of patients with chronic obstructive pulmonary disease (COPD), the extent of this impact based on the degree of deterioration is unclear. COPD Assessment Test (CAT) scores increase during exacerbations, reflecting symptom worsening. This study aimed to compare healthcare resource utilisation and mortality among patients with COPD after a severe exacerbation, stratified by changes in CAT scores. Methods: This observational study included patients hospitalised for COPD exacerbation. The CAT questionnaire was administered twice: once referring to the time of admission and once to the stable phase. Patients were divided into tertiles based on symptom worsening. A prospective follow-up was conducted to compare emergency room visits, hospital admissions, and survival rates. Results: This study included 50 patients, of whom 30 (60%) were male. Their mean age was 70.5 years (standard deviation [SD]: 9.6), mean forced expiratory volume in the first second (FEV1) was 46.7% (SD: 0.8) of the predicted value, and median CAT score deterioration was 9 points (interquartile range: 5–15.25). Patients in the third tertile had earlier healthcare utilisation than those in the first tertile (emergency room visits: log-rank = 5.27, p = 0.022; hospitalisations: log-rank = 5.27, p = 0.022). Survival rates did not differ significantly among tertiles. Conclusions: Patients with greater CAT score deterioration experienced earlier COPD-related events, suggesting the need for closer monitoring after severe exacerbation. Full article

Introduction/Objective: The relationship between chronic obstructive pulmonary disease (COPD) and overweight is complex and multifaceted, as these conditions can interact in terms of symptoms, severity and clinical management. To analyse the clinical and therapeutic management of patients suffering from COPD and overweight. Methods: This systematic review was carried out, in accordance with the PRISMA statement, during November 2024, following a search of the Medline/PubMed databases. The search equation used, with MESH descriptors, was: “(Pulmonary Disease, Chronic Obstructive OR COPD) AND (obesity OR overweight)”. Both inclusion and exclusion criteria were applied, focusing on the selection of clinical trials. The studies were classified into two main groups: by their focus on the relationship between overweight/obesity and COPD; and by the benefits provided by physical exercise to patients with these conditions. A random-effects meta-analysis was performed on the data obtained. The protocol was registered in the PROSPERO International Prospective Register of Systematic Reviews (CRD42024576389). Results: The search produced nine relevant clinical trials with a total of 1345 COPD patients. Four of the trials incorporated obesity (BMI ≥ 30) as an inclusion criterion, while the other five had mixed samples, with patients presenting either overweight or obesity (four patients with BMI ≥ 25 and one with BMI ≥ 27). The risk of bias tool for randomised trials showed that all nine studies had a low risk of bias. Overall, these studies highlight the importance of overweight management and reject the use of extreme measures. Furthermore, they confirm the association between overweight/obesity and COPD, for which this condition is a risk factor, to a degree depending on the BMI. Four studies reported significant improvements in the clinical management of COPD patients following appropriate physical exercise. Specifically, one study observed that supervised exercise improved cardio-vascular performance; another, that observed that aquatic exercise increased maximal capacity, endurance and quality of life; another, that found cycling improved ventilatory performance; and the fourth, that observed exercise complementary to standard therapy in hospitalised obese COPD patients improved strength, exercise capacity and other perceived variables such as anxiety, mobility and dyspnoea. Conclusions: The therapeutic management of overweight COPD patients should include weight control, physical exercise and appropriate pharmacological treatment. Physical exercise is associated with improvements in endurance, exercise capacity, cardio-vascular performance, ventilatory performance and strength. In addition, the participants in these studies self-perceived clinical improvement. These findings justify the performance of further RCTs examining the role of physical exercise in patients with COPD and overweight/obesity, in order to improve their clinical outcomes and quality of life. Full article

Background: Atrial fibrillation (AF) patients represent a clinically complex, heterogeneous population comprising multiple homogeneous cohorts. Purpose: We aimed to identify the common clinical phenotypes of AF patients and compare clinical outcomes between these subgroups. Methods: A 1% representative sample of all AF patients hospitalized between 2010 and 2019 was identified from the French national database. Agglomerative hierarchical cluster analysis was performed using Ward’s method and squared Euclidian distance to derive the clusters of patients. Cox regression analyses were used to evaluate outcomes including all-cause death, cardiovascular death, non-cardiovascular death, ischemic stroke, hospitalization for heart failure (HF) and composite of ventricular tachycardia, ventricular fibrillation and cardiac arrest (VT/VF/CA) over a mean follow-up period of 2.0 ± 2.3 years. Results: Four clusters were generated from the 12,688 patients included. Cluster 1 (n = 2375) was younger, low cardiovascular disease (CVD)-risk group with a high cancer prevalence. Clusters 2 (n = 6441) and 3 (n = 1639) depicted moderate-risk groups for CVD. Cluster 3 also had the highest degree of frailty and lung disease while Cluster 4 (n = 2233) represented a high-risk cohort for CVD. After adjusting for confounders, with cluster 1 as the reference, cluster 3 had the highest risk of all-cause death, HR 1.24 (1.09–1.41), ARD (10.3%), cardiovascular death, HR 1.56 (1.19–2.06), ARD (3.3%), non-cardiovascular death, HR 1.20 (1.04–1.38), ARD (6.9%), hospitalization for HF, HR 2.07 (1.71–2.50), ARD (9.1%) and VT/VF/CA, HR 1.74 (1.20–2.53), (ARD 1.3%). Conclusions: Four distinct clusters of AF patients were identified, discriminated by the differential presence of comorbidities. Our findings suggest that hospitalized AF patients with moderate CVD risk may have a poorer prognosis compared to hospitalized AF patients with high CVD risk in the presence of lung pathology and frailty. This subgroup of patients may require more stringent management of existing comorbidities such as chronic obstructive pulmonary disease and sleep apnea, alongside their AF. Full article