Search Results (49,562)

Background and Objectives: Postoperative delirium and postoperative cognitive dysfunction are common complications in older adults undergoing elective non-cardiac surgery, associated with increased morbidity and mortality, functional decline, and prolonged hospital stay. Prolonged preoperative fasting may intensify inflammatory responses and insulin resistance. Preoperative oral carbohydrate loading within ERAS protocols may modulate this response and reduce cognitive risk. Materials and Methods: A scoping review was conducted following the methodological recommendations of Arksey and O’Malley, the Joanna Briggs Institute, and PRISMA-ScR. A systematic search was performed in PubMed and Scopus for studies published up to September 2025. Randomized controlled trials and observational studies including adults ≥ 65 years undergoing elective non-cardiac surgery were included if they evaluated fasting modifications or preoperative carbohydrate loading and reported postoperative delirium or cognitive dysfunction. Results: A total of eight publications were included: four randomized controlled trials, one prospective cohort study, two cross-sectional studies, and one descriptive/correlational study. Populations included older adults undergoing elective abdominal, orthopedic, colorectal, or hip surgery, as well as hospitalized elderly surgical patients. Interventions included oral carbohydrate loading, assessment of preoperative nutritional status, and enteral versus parenteral nutrition. Only four of the eight included studies directly evaluated neurocognitive outcomes. Postoperative delirium was assessed in three studies, using the Confusion Assessment Method in two studies and the Delirium Rating Scale in one study. Postoperative cognitive dysfunction was evaluated in one study using a Mini-Mental State Examination-based cognitive assessment, while the remaining four studies did not assess neurocognitive outcomes and instead focused on metabolic, inflammatory, or perioperative well-being outcomes. Conclusions: Available evidence suggests that perioperative fasting protocols and preoperative carbohydrate loading may influence metabolic and inflammatory responses related to postoperative neurocognitive outcomes in older adults. However, evidence remains limited and heterogeneous. Findings are exploratory and hypothesis-generating, highlighting the need for well-designed trials assessing neurocognitive outcomes in geriatric surgical populations. Full article

Retrofitting existing buildings is widely recognized as a critical strategy for achieving global decarbonization goals. As a part of this effort, several tools have been developed for building retrofit analysis, each offering distinct advantages and limitations. However, the current approaches and tools still lack the capability to generate well-calibrated detailed building energy models that can evaluate both individual and combined energy efficiency measures. Moreover, no existing analysis tool can identify the most cost-optimal combination of retrofit measures through a comprehensive optimization search using different objectives. To address these shortcomings, this paper describes a new Simplified and Automated Building Energy Retrofit (SABER) analysis approach and tool. The SABER tool is a Python-based interactive platform designed to assist users by automatically creating detailed energy models of existing buildings. It incorporates a novel automatic calibration algorithm that adjusts operational schedules using building energy signature characteristics, ensuring accurate model performance. In addition, SABER can assess various building energy efficiency measures using a sequential search technique to determine the most cost-effective retrofit packages. This paper describes the key functionalities of SABER and demonstrates its capabilities through two residential building case studies. By integrating several key features into a unified framework, SABER represents a significant step toward the next generation of building energy retrofit analysis tools that can effectively assist the industry’s transition to a sustainable future. Full article

Background/Objectives: To develop and internally validate multiple linear regression models to predict estimated VO2max from anthropometric variables and easily obtainable physical fitness tests in active university students and to compare model performance when estimated VO2max was derived from the Rockport Walk Test versus the 20-m Shuttle Run (Course Navette). Methods: Anthropometric variables and physical fitness indicators, including body mass index (BMI), Ruffier index, and burpee repetitions, as well as sex and age, were evaluated. Estimated VO2max was obtained separately from the Rockport Walk Test and the 20-m Shuttle Run using their respective field test equations. For each test, a multiple linear regression model was fitted using the same set of predictors. Model performance was assessed using apparent metrics and internal validation with optimism correction based on repeated cross-validation. Results: The Rockport walk test model showed better predictive performance, explaining 55.2% of the variability in estimated VO2max (R² = 0.552; adjusted R² = 0.498) with a lower prediction error (RMSE = 3.54 mL·kg⁻¹·min⁻¹). In contrast, the 20-m shuttle run model showed lower explanatory capacity (R² = 0.319; adjusted R² = 0.256) and a substantially higher prediction error (RMSE = 11.93 mL·kg⁻¹·min⁻¹). Internal validation reduced performance in both models, more markedly in the 20-m shuttle run, where the corrected R² fell to 0.163 and the corrected RMSE increased to 13.18 mL·kg⁻¹·min⁻¹, compared with 0.338 and 4.37 mL·kg⁻¹·min⁻¹ in the Rockport walk test. Conclusions: Estimated VO2max can be predicted pragmatically using low-cost models based on simple variables in a university setting; however, model performance depends on the field test used. The Rockport walk test appears more suitable for prediction using general-purpose predictors, whereas the 20-m shuttle run may require more test-specific predictors and external validation before application beyond the development sample. Full article

Background: In reverse shoulder arthroplasty (RSA), preservation of the subscapularis (SSC) has gained attention because of its biomechanical and functional significance. However, when SSC preservation is attempted using the conventional deltopectoral (DP) approach, glenoid visualization and instrument access may be limited. The purpose of this Technical Note is to describe a modified deltopectoral exposure technique, hereafter referred to as the Margin-Shifted, Yawing, Subscapularis-Sparing, and Transitioned Lateralized Deltopectoral (MYST–LDP) approach, and to assess its feasibility in primary RSA. Methods: The MYST–LDP approach incorporates a laterally shifted incision apex, a proximally oriented curved arc (“yawing”) toward the acromion, complete preservation of the subscapularis, and a distally transitioned limb aligned with the anterior humeral axis. We describe the surgical technique and our initial experience in three consecutive primary RSA cases performed using an inlay implant system to minimize humeral lateralization and allow focused assessment of exposure geometry. Results: In all cases, the SSC was preserved without conversion to a standard DP exposure. Adequate glenoid visualization was achieved using three retractors without excessive soft-tissue tension, allowing controlled glenoid preparation and component implantation without additional exposure or conversion. No approach-related intraoperative complications were observed. Conclusions: The MYST–LDP approach is a feasible modification of the deltopectoral exposure that preserves both SSC and the deltoid while facilitating glenoid visualization and instrument alignment. This technique represents an ergonomic and tissue-preserving option within the familiar DP framework for surgeons performing SSC-preserving RSA. Further comparative and quantitative studies are warranted to determine its clinical value. Full article

Renal surgery for localized renal cell carcinoma carries substantial risk of acute kidney injury (AKI) regardless of surgical approach. This prospective study evaluated early biohumoral markers for AKI detection after robotic renal surgery and assessed their prognostic value for 12-month functional outcomes. Adults undergoing robotic renal tumor surgery with a healthy contralateral kidney were enrolled; AKI followed KDIGO 2012 criteria. Biomarkers measured at baseline and 2/24/72 h were serum β2-microglobulin (sβ2) serum IL-6, as well as urinary β2-microglobulin (uβ2), cystatin C (uC), and α2-macroglobulin (uα2M). Kidney function at 12 months was staged according to KDOQI criteria. Among 170 patients (35 radical nephrectomy, RN; 135 partial nephrectomy, PN), 33 developed AKI, more frequently after RN (p < 0.001); baseline biomarkers levels were similar. sβ2 was significantly higher at 2/24/72 h, and at 2 h, it achieved an AUC of 0.78 (cut-off 0.17: sensitivity 82%, specificity 60%), remaining the earliest independent predictor of AKI (p = 0.015). IL-6 differed at 24 h (AUC 0.80), uC at 72 h (AUC 0.73) and uβ2 at 72 h (AUC 0.66). Clinical AKI predicted KDOQI stage progression at 12 months (p < 0.001). Bulldog clamps (mean ischemia time 17.2 ± 6.9 min) were not associated with AKI (p = 0.99) or with KDOQI stage progression (p = 0.54). RN confers a higher AKI risk than PN. sβ2 at 2 h is the earliest actionable marker, complemented by IL-6 (24 h) and uC (72 h); short warm ischemia during robotic PN appears safe. Sequential multimarker assessment may improve recognition of AKI and support timely nephroprotective strategies. Full article

Background: Constipation is a common gastrointestinal (GI) state for which probiotics have shown promise as a relief. This study examined the laxative effects of the strain Bifidobacterium animalis subsp. lactis CECT 8145 (BPL1^®) in a loperamide-induced rat model of constipation. Methods: Fifty-nine rats were divided into control and loperamide-induced constipation groups. Animals received a 3-day intervention with either placebo or probiotic BPL1^® at two doses: 1.5 × 10⁸ CFU (colony-forming units) (low) and 3 × 10⁹ CFU (high). The study assessed several parameters to determine the probiotic’s effect, including: stool and gut characteristics, gastrointestinal transit time (GTT), gene expression and gut microbiome composition. Results: While loperamide significantly decreased stool number, weight and humidity, BPL1^® supplementation effectively restored these parameters, being more pronounced at a high dose. Microbiome analysis showed that BPL1^® at a low dose reduced the abundance of Muribaculaceae and Muribaculum gordoncarteri, associated with constipation. In addition, Muribaculaceae abundance was negatively correlated with stool humidity. Functional microbiome profiling indicated that BPL1^® suppressed pathways related to mucin degradation, vancomycin resistance and isoleucine biosynthesis while promoting L-lactate and pyridoxal-P (vitamin B6) biosynthesis, which may support gut motility and barrier integrity. Conclusions:Bifidobacterium animalis subsp. lactis BPL1^® exhibits potential as a functional probiotic for relieving constipation through improving stool excretion and consistency, inducing taxonomic changes and beneficial functional modulation of the intestinal microbiome. These findings justify further investigation into the mechanisms of BPL1^® as a probiotic for constipation management. Full article

Background/Objectives: Cisplatin is a potent chemotherapeutic agent whose clinical utility is limited by severe side effects, including neurotoxicity affecting the ocular system. The pathophysiology involves oxidative stress and mitochondrial dysfunction, to which the retina is particularly vulnerable. Selenium (Se), an essential trace element and component of antioxidant enzymes, has shown potential in mitigating cisplatin toxicity, although its efficacy with respect to retinal structure and the influence of administration routes remain underexplored. This study aimed to evaluate the protective efficacy of selenium against cisplatin-induced retinal toxicity and compare the effects of intraperitoneal and oral selenium administration. Methods: Forty adult male Wistar rats were randomized into four groups (n = 10 each): Group A (Cisplatin Monotherapy, 3.5 mg/kg IP for 5 days; cumulative dose 17.5 mg/kg); Group B (Cisplatin + Intraperitoneal Selenium, 2.73 mg/kg; cumulative dose 60 mg/kg); Group C (Control); and Group D (Cisplatin + Oral Selenium). Selenium prophylaxis, administered as sodium selenite (Na₂SeO₃), began two days prior to cisplatin administration and continued for 15 days post-treatment. Retinal evaluation two weeks after cisplatin cessation included light microscopy, semi-quantitative immunohistochemical (IHC) analysis for inflammatory (IL-6) and fibrotic (TGF-β2) markers, and Transmission Electron Microscopy (TEM) for ultrastructural analysis, which were the primary endpoints. Statistical differences in the IHC scores were analyzed via the Kruskal‒Wallis H test with Dunn’s post hoc comparisons. Results: Cisplatin monotherapy (Group A) caused severe disruption of the retinal architecture, including edema, reactive gliosis, and significant upregulation of IL-6 and TGF-β2. Ultrastructural analysis revealed mitochondrial swelling (cristolysis) and photoreceptor disk fragmentation. Intraperitoneal selenium (Group B) was associated with significant structural preservation and intact mitochondria, with TGF-β2 levels comparable to those of the controls, although the IL-6 level remained moderately elevated. Conversely, oral selenium (Group D) suppressed both IL-6 and TGF-β2 expression to near-negative levels but provided less ultrastructural protection, resulting in persistent mitochondrial swelling and focal photoreceptor disruption. Conclusions: Systemic cisplatin induces severe subcellular retinal toxicity characterized by mitochondrial damage and photoreceptor degeneration. Selenium supplementation attenuates these effects; however, outcome patterns differ by administration route. Intraperitoneal selenium was associated with greater morphological and ultrastructural preservation despite persistent IL-6 elevation, whereas oral selenium normalized immunohistochemical marker expression to near-control levels but was associated with more pronounced residual subcellular damage on qualitative TEM assessment. These preliminary morphological and immunohistochemical findings suggest that the route of selenium delivery may influence its neuroprotective profile; however, pharmacokinetic measurements and functional retinal assessments, such as electroretinography, are warranted before its clinical translation. Full article

Background: Adequate muscle perfusion, particularly at the level of muscle microcirculation (MM), is essential for muscle function, recovery, and tissue health. Percussive therapy (PT) is increasingly used to support recovery and injury prevention and has shown consistent benefits for range of motion and perceived recovery. However, the underlying physiological mechanisms remain insufficiently understood, and evidence regarding its effects on MM is limited. This study investigated the acute effect of a single PT session on MM and muscle oxygen saturation (SmO₂). Methods: Twenty-two healthy volunteers (24.2 ± 3.0 years) underwent a single PT application (two or four minutes) to the thigh using a handheld percussive device. MM, SmO₂, and the perceived somatosensory sensation (PSS) were assessed at baseline and at five-minute intervals up to 40 min post-application. Data were analyzed using linear mixed models adjusted for age, lower-body fat percentage, and intervention duration. Results: A significant main effect of time was found for both MM and SmO₂. MM increased significantly compared to baseline from 5 to 15 min post-application (all p < 0.001), while SmO₂ increased immediately after PT and remained elevated throughout the 40-min observation period (all p < 0.001). PSS increased significantly during the first 20 min (all p < 0.02) before returning to baseline. Conclusions: A single PT application was associated with transient increases in MM and sustained elevations in SmO₂, along with associated subjective sensations. These time-associated changes suggest that PT may enhance local muscle perfusion and therefore contribute to the understanding of its physiological mechanisms. Full article

This study develops a Life-Cycle Sustainability Framework for circular business models in the context of post-war economic reconstruction and sustainable value chain transformation. Ukraine is used as the main case study due to its post-war reconstruction context and the need for resource-efficient economic recovery strategies. Under conditions of disrupted supply systems, resource constraints, and structural economic change, circular economy principles are conceptualized as strategic mechanisms for enhancing resilience, resource efficiency, and long-term competitiveness rather than solely as environmental policy instruments. Building on a structured hierarchy of circular business models aligned with product life-cycle stages, the framework emphasizes value retention through functional and usage extension beyond material recovery. The framework includes a hierarchical classification of 12 circular business models and a sustainability evaluation approach based on four criteria (K1–K4), which allow for the comparative assessment of circular business models and their combinations across life-cycle stages. Using secondary statistical data and policy review as analytical inputs, the study identifies sectors with high potential for circular transformation and sustainable investment, including agriculture, energy, industry, construction, and logistics. The results indicate that circular business models applied at early life-cycle stages, such as reuse, repair, and remanufacturing, provide the highest potential for reducing resource intensity and improving long-term economic sustainability, while recycling and energy recovery play a supporting role. These findings highlight how life-cycle-oriented circular strategies can support sustainable reconstruction pathways, strengthen international cooperation, and inform policy and managerial decision-making in transitional economic contexts. Full article

The exploitation into new materials of even the smallest scraps of textiles would contribute to their possible success in sectors such as the automotive industry. In this work, alkaline treatment with low sodium hydroxide (NaOH) concentrations was applied to flax and hemp textile residues, aiming to determine the most suitable process conditions as a function of the quality of the treated fibres. Several parameters were considered: the temperature and the concentration of the alkaline solution and the immersion time in the alkaline solution and, eventually, in distilled water during the neutralization phase. Drying tests were carried out under controlled temperature conditions to assess the effects of the various treatment parameters. The effects of the various procedures were elucidated by thermogravimetric analysis (TGA), scanning electron microscopy (SEM), X-ray diffraction (XRD) to assess crystallinity, atomic force microscopy (AFM) to characterize surface roughness, and nitrogen absorption/desorption cycles to determine how microporosity develops with treatment. It is suggested that only the 1.5 wt./vol.% treatment produced some worthwhile modifications of the fibres to prepare them for their use in composites, more evidently in flax than in hemp, though care needs to be taken about fibre embrittlement and potential water permeability. Full article

A comprehensive management framework integrating environmental and agronomic factors is critical for stable and resource-efficient rice production. The primary objective of this study was to develop an optimization framework for transplanted rice in Jiangsu Province, China, using a Generalized Additive Model (GAM). The framework was used to quantify the inter-annual stability of optimized management schemes and assess their sensitivity to future climate scenarios. The study evaluated the model’s generalization capability using two cross-validation strategies: Leave-One-Year-Out (LOYO) and Leave-One-Site-Out (LOSO). By predicting the yield of each candidate, the scheme maximizing yield was selected as the annual optimal management practice. Validation results demonstrated robust generalization capabilities across both spatial and temporal dimensions, with the model achieving an R² of 0.66 and an RMSE of 836 kg ha⁻¹ in LOSO validation, and an R² of 0.61 and an RMSE of 848 kg ha⁻¹ in LOYO validation. Analysis of the optimized schemes revealed that transplanting date and seedling age functioned as relatively stable planning benchmarks across years, whereas inter-annual adaptation was achieved primarily through adjustments in planting density and nitrogen inputs. Beyond yield prediction alone, this framework translates interpretable GAM response surfaces into spatially differentiated management prescriptions and highlights both soil-conditioned variable-rate strategies and the distinction between stable and adaptive management components under future climate scenarios. Full article

Environmental, genetic, immunological and metabolic factors are involved in renal cell carcinoma development. Clear cell renal carcinoma (ccRCC) is the most frequent renal cancer, with a complex metabolic physiopathology. The present study focuses on the characterization of chemical changes in glutathione redox homeostasis induced by oxidative damage and their relevance to ccRCC. We developed a prospective, case–control study that included 92 subjects diagnosed with ccRCC by histopathological exam and 40 healthy subjects. In each subject, we evaluated the chemical changes in glutathione redox homeostasis, antioxidative capacity, nitrosative stress, carbonyl stress, inflammation (IL-12 family members, albumin), angiogenesis factors and apoptosis. Compared to the control, in ccRCC subjects, we detected high levels of oxidative/electrophile stress, of hypoxia, and of inflammatory- and angiogenesis-related factors and low levels of anti-inflammatory-, anti-oxidative- and apoptosis-related factors. In ccRCC, positive correlations between glutathione redox homeostasis members expression and electrophile metabolites levels, respectively, angiogenesis markers and inflammatory parameters detected. Negative relations with anti-inflammatory and antioxidant markers were assessed. Glutathione redox homeostasis was altered in ccRCC, functioning as an active redox mechanism, with an essential role in the development and progression of ccRCC. Full article

Clear-cell renal cell carcinoma (ccRCC) is characterised by constitutive activation of hypoxia-inducible factors (HIFs) following VHL loss, which contributes to tumour progression and therapeutic resistance. Given the limitations of VEGFR-targeted therapies, we investigated the biological and potential therapeutic relevance of the HIF axis in ccRCC. Nuclear and cytoplasmic HIF1A and EPAS1/HIF2A expression were assessed by immunohistochemistry in tumours from 40 patients and correlated with clinicopathological parameters and cancer-specific survival. The functional effects of HIF pathway inhibitors (GN44028, KC7F2, and FM19G11) and sunitinib were analysed in VHL-mutant 786-O and VHL-wild-type Caki-1 cell lines using SRB viability assay, cell cycle analysis, wound closure assay, and RT-qPCR of HIF-related genes, with comparison to non-malignant HK-2 cells. TCGA-ccRCC data from advanced-stage patients (III–IV, n = 185) were analysed as a complementary transcriptomic context. Nuclear, but not cytoplasmic, HIF1A and EPAS1/HIF2A expression was associated with advanced stage and shorter survival in univariable analyses. GN44028 showed the most pronounced antiproliferative effect under tested conditions and was associated with broad suppression of HIF-related transcription, whereas sunitinib was associated with increased expression of selected HIF-related genes. GN44028 did not demonstrate clear selectivity over non-malignant HK-2 cells. Overall, nuclear HIF activation is associated with aggressive ccRCC biology, and broader HIF pathway modulation warrants further experimental investigation; however, the clinical findings remain exploratory, and therapeutic selectivity and translational relevance are not yet established. Full article

Introduction: Asthma is one of the most common chronic diseases in childhood and represents a major global public health concern due to its high prevalence, healthcare burden, and impact on quality of life. Pediatric asthma is characterized by clinical and biological heterogeneity, reflected in variable airflow limitations and distinct inflammatory endotypes. Conventional diagnostic tools do not fully capture the metabolic mechanisms underlying lung function impairment and disease variability. Aim: This narrative review aims to synthesize evidence published linking metabolomic and breathomic signatures to lung function parameters in children with asthma. Methods: We searched PubMed, Scopus, and Google Scholar using predefined keywords including pediatric asthma, metabolomics, breathomics, volatile organic compounds, exhaled breath condensate, and lung function. The search covered publications from January 2015 to January 2026. Earlier studies were included when necessary for the conceptual or methodological context. We included human studies evaluating metabolomic or breathomic profiles in children (≤18 years) and reporting associations with lung function, severity, endotypes, or exacerbations. Duplicate records, adult-only studies, animal models, non-English publications, and conference abstracts without full data were excluded. Results: Alterations in lipid and sphingolipid metabolism, oxidative stress pathways, and purine metabolism were associated with airflow limitation and reduced FEV1. Breathomic analyses revealed associations between volatile profiles, small airway dysfunction, and inflammatory patterns. However, findings remain heterogeneous across biological matrices and analytical platforms. Conclusions: Metabolomic and breathomic profiling may complement conventional lung function assessment by providing additional mechanistic insight into pediatric asthma heterogeneity. Standardized methodologies, longitudinal validation, and integration within multi-omics approaches are required before routine clinical implementation. Full article