Search Results (6,164)

Introduction: Finger injuries are common in pediatric patients and typically heal well with conservative management. However, rare fracture patterns involving significant displacement and physeal injury, such as the one described in this case, require specialized surgical intervention to ensure proper healing and prevent long-term complications. Case Presentation: A 12-year-old left-hand-dominant female presented with pain, swelling, and deformity at the distal interphalangeal (DIP) joint following hyperextension of the left fifth digit. Initial radiographs revealed a volar displaced intra-articular fracture with physis involvement, confirmed by computed tomography (CT) imaging. Conservative management with closed reduction and splinting failed to achieve adequate alignment. Surgical intervention was performed via a dorsal approach, utilizing ORIF with K-wire fixation to restore joint congruity and ensure anatomic alignment. Outcomes: Postoperative follow-up demonstrated satisfactory healing, maintained reduction, and resolution of pain with no complications. The patient regained functional use of the digit with minimal stiffness, and the growth plate remained uninvolved during the recovery period. Discussion: This case underscores the importance of advanced imaging, early referral, and tailored surgical intervention for rare mallet fractures involving volar displacement and physeal injury. ORIF provided reliable stabilization and optimal outcomes in this complex case. Conclusions: Volar displaced Salter–Harris III fractures of the DIP joint are rare and challenging injuries in pediatric patients. This case highlights the role of ORIF in achieving successful outcomes and emphasizes the importance of precise reduction and stabilization to prevent long-term complications. Full article

This comprehensive review examines the role of septoplasty in the pediatric population, emphasizing its therapeutic significance in relieving nasal obstruction and facilitating normal craniofacial growth. Despite the evident advantages of septoplasty, its application in young patients remains a subject of ongoing debate. This issue is primarily characterized by concerns regarding the still-developing immaturity of nasal cartilage, potential intraoperative and postoperative risks, and the current absence of robust data on long-term outcomes following septoplasty. Common complications such as bleeding, septal perforation, saddle nose deformity, and persistent nasal obstruction are reported in the literature; however, many studies lack long-term follow-up data on the incidence of these adverse events and revision rates, which may be higher compared to adult populations, often leading to the need for secondary surgical interventions. Strict inclusion criteria and comprehensive patient selection are paramount to maximize therapeutic success while minimizing complications. Current evidence suggests that appropriately indicated septoplasty can improve airway patency, support optimal facial development, and reduce the risk of secondary sinonasal pathology. There is a significant necessity for additional prospective, large-scale studies to establish standardized therapeutic guidelines and management strategies for this specific population, thereby ensuring effective and evidence-based pediatric otolaryngologic care. Full article

Background: Thyroid eye disease (TED) is a rare autoimmune orbital disorder predominantly associated with Graves’ disease. It is characterized by orbital inflammation, tissue remodeling, and potential visual morbidity. Conventional therapies, particularly systemic glucocorticoids, offer only partial symptomatic relief, failing to reverse chronic structural changes such as proptosis and diplopia, and are associated with substantial adverse effects. This review aims to synthesize recent developments in understandings of TED pathogenesis and to critically evaluate emerging therapeutic strategies. Methods: A systematic literature review was conducted using MEDLINE, Embase, and international clinical trial registries focusing on pivotal clinical trials and investigational therapies targeting core molecular pathways involved in TED. Results: Current evidence suggests that TED pathogenesis is primarily driven by the autoimmune activation of orbital fibroblasts (OFs) through thyrotropin receptor (TSH-R) and insulin-like growth factor-1 receptor (IGF-1R) signaling. Teprotumumab, a monoclonal IGF-1R inhibitor and the first therapy approved by the U.S. Food and Drug Administration for TED, has demonstrated substantial clinical benefit, including improvements in proptosis, diplopia, and quality of life. However, concerns remain regarding relapse rates and treatment-associated adverse events, particularly hearing impairment. Investigational therapies, including next-generation IGF-1R inhibitors, small-molecule antagonists, TSH-R inhibitors, neonatal Fc receptor (FcRn) blockers, cytokine-targeting agents, and gene-based interventions, are under development. These novel approaches aim to address both inflammatory and fibrotic components of TED. Conclusions: Teprotumumab has changed TED management but sustained control and toxicity reduction remain challenges. Future therapies should focus on targeted, mechanism-based, personalized approaches to improve long-term outcomes and patient quality of life. Full article

This study investigates the role of Big Data Analytics Capabilities (BDACs) in ambidexterity explorative innovation (EXPLRI) and exploitative (EXPLOI) innovation for achieving a sustainable performance (SP) in the manufacturing sector of a resource-constrained developing economy. While a BDAC has been widely linked to innovation in developed economies, its effectiveness in developing contexts shaped by indigenous innovation practices like Jugaad remains underexplored. Anchored in the Resource-Based View (RBV) and Dynamic Capabilities (DC) theory, we propose a model where the BDAC enhances both EXPLRI and EXPLOI, which subsequently leads to an improved sustainable performance. We further examine the Jugaad capability as a cultural moderator. Using survey data from 418 manufacturing firms and analyzed via Partial Least Squares Structural Equation Modeling (PLS-SEM), results confirm that BDA capabilities significantly boost both types of innovations, which positively impact sustainable performance dimensions. Notably, Jugaad positively moderates the relationship between EXPLOI and financial, innovation, and operational performance but negatively moderates the link between EXPLRI and innovation performance. These findings highlight the nuanced influence of culturally embedded innovation practices in BDAC-driven ecosystems. This study contributes by extending the RBV–DC framework to include cultural innovation capabilities and empirically validating the contingent role of Jugaad in enhancing or constraining innovation outcomes. This study also validated the Jugaad capability measurement instrument for the first time in the context of Pakistan. For practitioners, aligning data analytics strategies with local innovative cultures is vital for sustainable growth in emerging markets. Full article

Brain metastases are a common and deadly complication of many primary tumors. The progression of these tumors is poorly understood, and treatment options are limited. Two important components of tumor growth are hypoxia and angiogenesis. We conducted a review to look at the possibility of a symbiotic relationship between two transcription factors, Hypoxia-Inducible Factor 1α (HIF1α) and Vascular Endothelial Growth Factor (VEGF), and the role they play in metastasis to the brain. We delve further into this possible relationship by examining commonly used chemotherapeutic agents and their targets. Through an extensive literature review, we identified articles that provided evidence of a strong connection between these transcription factors and the growth of brain metastases, many highlighting a symbiotic relationship. Further supporting this, combinations of chemotherapeutic drugs with varying targets have increased the efficacy of treatment. Angiogenesis and hypoxia have long been known to play a large role in the invasion, growth, and poor outcomes of tumors. However, it is not fully understood how these factors influence one another during metastases. While prior studies have investigated the effects separately, we specifically delve into the synergistic and compounding effects that may exist between them. Our findings underscore the need for greater research allocation to investigate the possible symbiotic relationship between angiogenesis and hypoxia in brain metastasis. Full article

Background/Objectives: Medulloblastoma is the most common malignant brain tumor in children and comprises four molecular subtypes—WNT, SHH, Group 3, and Group 4—each with distinct genetic, epigenetic, and metabolic features. Increasing evidence highlights the critical role of metabolic reprogramming and epigenetic alterations in driving tumor progression, therapy resistance, and clinical outcomes. This review aims to explore the interplay between metabolic and epigenetic mechanisms in medulloblastoma, with a focus on their functional roles and therapeutic implications. Methods: A comprehensive literature review was conducted using PubMed and relevant databases, focusing on recent studies examining metabolic pathways and epigenetic regulation in medulloblastoma subtypes. Particular attention was given to experimental findings from in vitro and in vivo models, as well as emerging preclinical therapeutic strategies targeting these pathways. Results: Medulloblastoma exhibits metabolic adaptations such as increased glycolysis, lipid biosynthesis, and altered amino acid metabolism. These changes support rapid cell proliferation and interact with the tumor microenvironment. Concurrently, epigenetic mechanisms—including DNA methylation, histone modification, chromatin remodeling, and non-coding RNA regulation—contribute to tumor aggressiveness and treatment resistance. Notably, metabolic intermediates often serve as cofactors for epigenetic enzymes, creating feedback loops that reinforce oncogenic states. Preclinical studies suggest that targeting metabolic vulnerabilities or epigenetic regulators—and particularly their combination—can suppress tumor growth and overcome resistance mechanisms. Conclusions: The metabolic–epigenetic crosstalk in medulloblastoma represents a promising area for therapeutic innovation. Understanding subtype-specific dependencies and integrating biomarkers for patient stratification could facilitate the development of precision medicine approaches that improve outcomes and reduce long-term treatment-related toxicity in pediatric patients. Full article

Background: Diabetic foot ulcers (DFUs) are a serious complication of diabetes and are often difficult to treat. Hyperbaric oxygen therapy (HBOT) has been proposed as an adjunctive treatment to promote healing, but its long-term clinical and biological effects remain insufficiently characterized. This study aimed to evaluate the impact of HBOT on systemic biomarkers, local microvasculature, and clinical outcomes in patients with DFUs. Methods: In this non-randomized prospective study, 20 patients with ischemic DFUs were followed over a 36-month period. Fourteen received HBOT in addition to standard care, while six received standard care alone. Clinical outcomes—including DFU resolution, recurrence, lower extremity amputation (LEA), and mortality—were assessed alongside systemic inflammatory and angiogenic biomarkers and wound characteristics at baseline and at 3, 6, 12, and 36 months. CD31 immunostaining was performed on available tissue samples. Results: The two groups were comparable at baseline (mean age 62 ± 12 years; diabetes duration 18 ± 9 years). At 3 months, the HBOT group showed significant reductions in erythrocyte sedimentation rate and DFU size (p < 0.05), with downward trends observed in C-reactive protein (CRP), vascular endothelial growth factor (VEGF), and placental growth factor (PlGF), and an increase in stromal-derived factor-1 alpha (SDF1-α). No significant changes were observed in the control group. CD31+ microvessel density appeared to increase in HBOT-treated DFU tissue after one month, although the sample size was limited. Patients receiving HBOT had lower rates of LEA and mortality, improved wound healing, and sustained outcomes over three years. DFU recurrence rates were similar between groups. Conclusions: HBOT was associated with improved wound healing and favorable biomarker profiles in patients with treatment-resistant ischemic DFUs. While these findings are encouraging, the small sample size and non-randomized design limit their generalizability, highlighting the need for larger, controlled studies. Full article

The sustainable development of Chinese cities is of long-term significance. Multiple environmental regulatory instruments aim to promote the parallel advancement of environmental conservation and economic growth. This study examines three batches of low-carbon city pilot (LCCP) programs, employing eco-efficiency as the outcome variable. Using conventional difference-in-differences (DID) models, time-varying DID models, and period-by-period propensity score matching DID (PSM-DID) models with city and time fixed effects, we investigate the comprehensive impact of pilot policies on both economic and environmental performance. Eco-efficiency, measured through the Data Envelopment Analysis (DEA) model, exhibits a strong correlation with energy consumption patterns, as carbon emissions and air pollutants predominantly originate from non-clean energy utilization. The analysis reveals that LCCP policies significantly enhance eco-efficiency. These findings demonstrate robustness across placebo tests, endogeneity treatments, and alternative outcome variable specifications. The first and third LCCP batches significantly improve eco-efficiency, whereas the second batch demonstrates no statistically significant effect. Significant impacts emerge in regions where cities hold pilot status while provinces do not; conversely, regions where both cities and provinces participate in pilot programs show no significant effects. Finally, from an energy consumption perspective, policy recommendations are proposed to further enhance eco-efficiency through regulatory instruments. Full article

Background: Epidermal growth factor receptor (EGFR) mutations are presented in approximately 50% of East Asian populations with advanced non-small cell lung cancer (NSCLC). While EGFR-tyrosine kinase inhibitors (TKIs) are the standard treatment, patient outcomes are also influenced by host-related factors. This study aimed to investigate clinical and radiological factors associated with early mortality and develop a prognostic prediction model in advanced EGFR-mutated NSCLC. Methods: A retrospective cohort was conducted in patients with EGFR-mutated NSCLC treated with first line EGFR-TKIs from January 2012 to October 2022 at Chiang Mai University Hospital. Clinical data and radiologic findings at the initiation of treatment were analyzed. A multivariable flexible parametric survival model was used to determine the predictors of death at 18 months. The predicted survival probabilities at 6, 12, and 18 months were estimated, and the model performance was evaluated. Results: Among 189 patients, 84 (44.4%) died within 18 months. Significant predictors of mortality included body mass index <18.5 or ≥23, bone metastasis, neutrophil-to-lymphocyte ratio ≥ 5, albumin-to-globulin ratio < 1, and mean pulmonary artery diameter ≥ 29 mm. The model demonstrated good performance (Harrell’s C-statistic = 0.72; 95% CI: 0.66–0.78). Based on bootstrap internal validation, the optimism-corrected Harrell’s C-statistic was 0.71 (95% CI: 0.71–0.71), derived from an apparent C-statistic of 0.75 (95% CI: 0.74–0.75) and an estimated optimism of 0.04 (95% CI: 0.03–0.04). Estimated 18-month survival ranged from 87.1% in those without risk factors to 2.1% in those with all predictors. A web-based tool was developed for clinical use. Conclusions: The prognostic model developed from fundamental clinical and radiologic parameters demonstrated promising utility in predicting 18-month mortality in patients with advanced EGFR-mutated NSCLC receiving first-line EGFR-TKI therapy. Full article

Background/Objectives: Growth prediction may be used by the clinical orthodontist in growing individuals for diagnostic purposes and for treatment planning. This process appraises chronological age and determines the degree of skeletal maturity to calculate residual growth. In developmental deviations, overlooking such diagnostic details might culminate in erroneous conclusions, unstable outcomes, recurrence, and treatment failure. The present review aims to systematically present and explain the available means for predicting growth in humans. Traditional, long-known, popular methods are discussed, and modern digital applications are described. Materials and methods: A search on PubMed and the gray literature up to May 2025 produced 69 eligible studies on future maxillofacial growth prediction without any orthodontic intervention. Results: Substantial variability exists in the studies on growth prediction. In young orthodontic patients, the study of the lateral cephalometric radiography and the subsequent calculation of planes and angles remain questionable for diagnosis and treatment planning. Skeletal age assessment is readily accomplished with X-rays of the cervical vertebrae and the hand–wrist region. Computer software is being implemented to improve the reliability of classic methodologies. Metal implants have been used in seminal growth studies. Biochemical methods and electromyography have been suggested for clinical prediction and for research purposes. Conclusions: In young patients, it would be of importance to reach conclusions on future growth with minimal distress to the individual and, also, reduced exposure to ionizing radiation. Nevertheless, the potential for comprehensive prediction is still largely lacking. It could be accomplished in the future by combining established methods with digital technology. Full article

Arbuscular mycorrhizal fungi (AMF) play a vital role in the restoration of tropical forests by enhancing soil fertility, facilitating plant establishment, and improving ecosystem resilience. This study presents a comprehensive bibliometric analysis of global scientific output on AMF in the context of ecological restoration, based on 3835 publications indexed in the Web of Science and Scopus databases from 2001 to 2024. An average annual growth rate of approximately 9.45% was observed, with contributions from 10,868 authors across 880 journals. The most prominent journals included Mycorrhiza (3.34%), New Phytologist (3.00%), and Applied Soil Ecology (2.79%). Thematically, dominant research areas encompassed soil–plant interactions, phytoremediation, biodiversity, and microbial ecology. Keyword co-occurrence analysis identified “arbuscular mycorrhizal fungi,” “diversity,” “soil,” and “plant growth” as core topics, while emerging topics such as rhizosphere interactions and responses to abiotic stress showed increasing prominence. Despite the expanding body of literature, key knowledge gaps remain, particularly concerning AMF–plant specificity, long-term restoration outcomes, and integration of microbial community dynamics. These findings offer critical insights into the development of AMF research and underscore its strategic importance in tropical forest restoration, providing a foundation for future studies and informing ecosystem management policies. Full article

Glioblastoma (GBM) remains one of the most aggressive and treatment-resistant brain tumors, largely due to its profound intratumoral heterogeneity and immunosuppressive microenvironment. Various classifications of GBM subtypes were created based on transcriptional and methylation profiles. This effort, followed by the development of new technology such as single-nuclei sequencing (snRNAseq) and spatial transcriptomics, led to a better understanding of the glioma cells’ plasticity and their ability to transition between diverse cellular states. GBM cells can mimic neurodevelopmental programs to resemble oligodendrocyte or neural progenitor behavior and hitchhike the local neuronal network to support their growth. The tumor microenvironment, especially under hypoxic conditions, drives the tumor cell clonal selection, which then reshapes the immune cells’ functions. These adaptations contribute to immune evasion by progressively disabling T cell and myeloid cell functions, ultimately establishing a highly immunosuppressive tumor milieu. This complex and metabolically constrained environment poses a major barrier to effective antitumor immunity and limits the success of conventional therapies. Understanding the dynamic interactions between glioma cells and their microenvironment is essential for the development of more effective immunotherapies and rational combination strategies aimed at overcoming resistance and improving patient outcomes. Full article

In this study, we examine the impact of mergers and acquisitions (M&As) on firm environmental performance, aiming to address the gap in research and guide firms, investors, and policymakers toward more environmentally conscious decision-making in M&A. Using panel data from Chinese A-share listed firms (2008–2022), we estimate a two-way fixed effect model. The Propensity Score Matching and the instrumental variable method address potential endogeneity concerns, and robustness checks validate the findings. We found that M&As have a significantly positive effect on firm environmental performance, with heterogeneous impacts across regions, industries, and M&A types. The environmental benefits are most pronounced in heavily polluting industries and hybrid M&A deals. Eastern China shows more modest improvements. The results of mechanism tests revealed that M&As enhance environmental performance primarily by boosting total factor productivity and fostering innovation. This study offers a novel perspective by linking M&A activities to environmental sustainability, enriching the literature on both M&As and corporate environmental performance. We show that even conventional M&A deals (not sustainability-focused) can improve environmental performance through operational synergies. Expanding beyond polluting industries, we reveal how sector characteristics shape M&A’s environmental impacts. We identify practical mechanisms through which standard M&A activities can advance sustainability goals, helping firms balance economic and environmental objectives. It provides empirical evidence from China, an emerging market with distinct institutional and regulatory contexts. The findings offer guidance for firms engaging in M&A to strategically improve sustainability performance. Policymakers can leverage these insights to design incentives for M&A in pollution-intensive industries, aligning economic growth with environmental goals. By demonstrating that M&As can enhance environmental outcomes, this study supports the potential for market-driven mechanisms to contribute to broader societal sustainability objectives, such as reduced industrial pollution and greener production practices. Full article

The 1.9 billion metric tons of steel globally manufactured in 2023 justify the steel industry’s pivotal role in modern society’s growth. Considering the rapid development of countries that have not fully taken part in the global market, such as Africa, steel production is expected to increase in the next decade. However, the environmental burden associated with steel manufacturing must be mitigated to achieve sustainable production, which would align with the European Green Deal pathway. Such a burden is associated both with the GHG emissions and with the solid residues arising from steel manufacturing, considering both the integrated and electrical routes. The valorisation of the main steel residues from the electrical steelmaking is the central theme of this work, referring to the steel electric manufacturing in the Dalmine case study. The investigation was carried out from two different points of view, comprising the action of a plasma electric reactor and a RecoDust unit to optimize the recovery of iron and zinc, respectively, being the two main technologies envisioned in the EU-funded research project ReMFra. This work focuses on those preliminary steps required to detect the optimal recipes to consider for such industrial units, such as thermodynamic modelling, testing the mechanical properties of the briquettes produced, and the smelting trials carried out at pilot scale. However, tests for the usability of the dusty feedstock for RecoDust are carried out, and, with the results, some recommendations for pretreatment can be made. The outcomes show the high potential of these streams for metal and mineral recovery. Full article

Systems thinking (ST) is a foundational cognitive skillset to advance sustainability education but has not been well examined for learners prior to higher education. This case study research in rural middle schools in the Midwestern U.S. examines systems thinking outcomes of a place-based energy literacy unit focused on energy-efficient building design. The unit employs the science of energy-efficient, green buildings to illuminate the ways in which energy flows between natural and built environments. The unit emphasized electrical, light, and thermal energy systems and the ways these systems interact to create functional and energy-efficient buildings. This study focuses on three case study classrooms where students across schools (n = 89 students) created systems models as part of pre- and post-unit tests (n = 162 models). The unit tests consisted of student drawings, annotations, and writings, culminating into student-developed systems models. Growth from pre- to post-test was observed in both the identification of system elements and the linkages between elements. System elements included in the models were common classroom features, such as windows, lights, and temperature control, suggesting that rooting the unit in place-based teaching may support ST skills. Full article