Search Results (20,427)

Background: Sarcopenia and frailty are highly prevalent extrapulmonary manifestations of chronic obstructive pulmonary disease (COPD) and are strongly associated with reduced exercise tolerance, exacerbation risk, hospitalizations, and mortality. Beyond inflammation, oxidative stress, and physical inactivity, emerging evidence highlights nutrition as a major modifiable driver of muscle deterioration in COPD. Nutritional deficits impair anabolic signaling, exacerbate proteolysis, worsen mitochondrial dysfunction, and contribute to frailty progression. Methods: This narrative review synthesizes evidence from PubMed, Embase, Scopus, and Web of Science up to 2025, integrating mechanistic, metabolic, nutritional, and biomarker-related pathways underlying muscle dysfunction in COPD. Studies examining inflammation, hypoxemia, oxidative stress, hormonal imbalance, nutrition, and emerging biomarkers were included. Results: COPD-related sarcopenia results from converging inflammatory (TNF-α, IL-6), catabolic (FOXO, UPS), metabolic, and vascular mechanisms, compounded by energy deficiency, protein insufficiency, and micronutrient deficits. Inadequate intake of protein, vitamin D, antioxidants, and omega-3 fatty acids increase anabolic resistance, enhance muscle catabolism, and worsen frailty. Nutritional interventions, particularly high-protein supplementation, leucine-enriched formulas, vitamin D repletion, omega-3 fatty acids, and multimodal nutrition–exercise programs, demonstrate benefits in muscle mass, strength, and physical performance. Biomarkers such as GDF-15, CAF22, and specific microRNAs reflect nutritional status and correlate with muscle health in COPD. Conclusions: Sarcopenia and frailty in COPD arise from a complex interplay of inflammatory, metabolic, nutritional, and lifestyle-related factors. Integrating nutritional assessment and targeted dietary interventions with exercise and pulmonary rehabilitation is essential to counteract anabolic resistance and improve functional outcomes. Advances in biomarker research may support earlier diagnosis and personalized nutrition-based therapeutic strategies. Full article

Chronic rhinosinusitis (CRS) constitutes a multicausal inflammatory disease of the nose and paranasal sinuses, often associated with olfactory dysfunction (OD), a symptom that significantly impacts patients’ quality of life. OD in CRS was traditionally thought to be related to mechanical obstruction of the olfactory cleft, but is now considered to be multifactorial, involving conductive, inflammatory, and sensorineural mechanisms as well. Type-2 inflammatory response (high interleukins IL-4, IL-5, IL-13), eosinophilia, and increased IgE are involved in epithelial damage, impaired neurogenesis, and persistent olfactory loss, especially in chronic rhinosinusitis with nasal polyps (CRSwNP). In addition, peripheral chronic inflammation may also play a role in central neural remodeling, which may potentially affect olfactory function. Objective psychophysical testing is necessary to accurately assess olfactory function because self-reports may lack reliability. Management strategies aim at reducing inflammation and restoring sinonasal ventilation. First-line therapy with intranasal corticosteroids and short courses of systemic corticosteroids may be useful for symptomatic relief. Biologic agents directed against type-2 inflammation have demonstrated significant benefits in selected cases. Functional Endoscopic Sinus Surgery (FESS) plays an important role in the treatment of refractory CRS to restore the airflow and to improve the delivery of topical drugs. Olfactory outcomes following surgery, however, are variable and often incomplete, reflecting underlying inflammation and neuroepithelial damage. Disease recurrence, especially in type-2–driven CRS, affects long-term outcomes, underscoring the necessity to incorporate surgery in an individualized, endotype-informed treatment strategy. Full article

Building inclusive, high-density cities requires understanding vulnerable groups’ public space usage. While green exposure significantly impacts urban health, existing research frequently overlooks females’ specific needs regarding streetscape visual quality, green space structures, and daily travel experiences. To address this, the study investigates spatial disparities in Suzhou’s historic district. Utilizing multi-source data and mixed modeling strategies, including Partial Least Squares and Ordinary Least Squares (PLS-OLS) and eXtreme Gradient Boosting (XGBoost), the research analyzes how streetscape perceptions and green space characteristics affect female life satisfaction and expressed sentiment. Results indicate three main findings. (1) Streetscape visual features fundamentally drive subjective evaluations. Safe significantly enhances well-being, whereas boring and lively negatively impact life satisfaction, reflecting females’ acute sensitivity to environmental oppressiveness during daily travel. (2) Park diversity elevates expressed sentiment, while patch density positively influences life satisfaction, demonstrating the vital value of fragmented greenery for daily public space usage. (3) Boring precipitously diminishes life satisfaction after surpassing a specific threshold, while park diversity elevates expressed sentiment only after crossing a critical interval. The study establishes an integrated analytical framework linking visual perception, green space structure, emotional response, and satisfaction. These findings provide targeted strategies for enhancing inclusive urban design and optimizing green space allocation to improve streetscape safety and alleviate visual oppressiveness, thereby advancing gender social justice for vulnerable groups in historic districts. Full article

Background: The triglyceride–glucose (TyG) index has emerged as a simple surrogate marker of insulin resistance and metabolic disruption. In the context of ST-elevation myocardial infarction (STEMI), such disturbances have been associated with adverse cardiovascular outcomes, more complex angiographic profiles, and microvascular complications. However, data on the association between TyG and intracoronary thrombus burden (TB) in STEMI remain limited. Methods: In this prospective observational study, we included consecutive STEMI patients treated with primary percutaneous coronary intervention (pPCI). The TyG index was calculated using the following formula: ln [fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2]. TB was graded according to the modified thrombolysis in myocardial infarction (mTIMI) thrombus classification score after restoration of antegrade flow with a wire or small balloon when the culprit vessel was initially totally occluded. Patients were categorized as low-TB (LTB; mTIMI grades 1–3) and high-TB (HTB; mTIMI grade 4). The primary outcome was HTB; secondary outcomes were distal embolization and no-reflow. Associations between TyG and outcomes were assessed using univariable and multivariable logistic regression, restricted cubic spline analysis, and receiver operating characteristic (ROC) curves to evaluate incremental predictive value. Results: A total of 309 patients were analyzed. The TyG index was significantly higher in the HTB group compared with the LTB group (9.12 ± 0.62 vs. 8.92 ± 0.64, p = 0.004). In a stepwise multivariable model, TyG remained independently associated with HTB (adjusted odds ratio = 1.61; 95% confidence interval: 1.11–2.37; p = 0.014). Adding TyG to a baseline clinical model only numerically improved discrimination for HTB, as reflected by a small increase in ROC area under the curve. Restricted cubic spline analysis demonstrated a monotonic rise in the probability of HTB with higher TyG values. Higher TyG also showed non-significant trends toward increased odds of distal embolization and no-reflow. Conclusions: The TyG index was independently associated with HTB in STEMI patients undergoing pPCI and may serve as an accessible adjunctive marker for incremental risk stratification beyond conventional clinical and angiographic factors. Full article

Background: Reflectance confocal microscopy (RCM) enables noninvasive, high-resolution visualization of skin tumors and may improve preoperative margin assessment in nonmelanoma skin cancer (NMSC). However, its impact on surgical outcomes in routine clinical practice remains incompletely defined. Objective: To evaluate surgical outcomes of NMSC managed with systematic preoperative RCM-guided margin assessment, comparing wide local excision (WLE) and Mohs micrographic surgery (MMS). Methods: We conducted a retrospective study of 71 consecutive NMSC treated at a tertiary dermatologic oncology center. All tumors underwent RCM evaluation for diagnosis and preoperative margin mapping. Outcomes included positive margins after WLE, local recurrence, recurrence-free survival, and the number of Mohs stages. Associations were analyzed using Fisher’s exact tests and Firth penalized logistic regression. Results: Among 47 tumors treated with WLE, positive margins occurred in 10.6%. Among 24 MMS cases, 70.8% were cleared in a single stage. Local recurrence occurred in 14.9% of WLE-treated tumors and in none of the MMS-treated tumors (p = 0.087). All recurrences occurred in tumors initially demonstrated positive margins after WLE, despite subsequent re-excision and histologic clearance. In multivariable Firth regression, MMS was associated with a lower risk of recurrence (OR 0.13; 95% CI, 0.008–2.10). Conclusions: In this RCM-guided cohort, low margin positivity after WLE and high single-stage clearance in MMS suggest improved surgical accuracy and efficiency. Recurrence was confined to margin-positive tumors, supporting a margin-driven model of tumor control and highlighting RCM as a potential preoperative margin-control strategy. Full article

Background: Preterm premature rupture of membranes (PPROM) before 32 weeks of gestation with prolonged latency is associated with substantial neonatal morbidity, including Dry Lung Syndrome (DLS), pulmonary hypoplasia (PH), bronchopulmonary dysplasia (BPD), and death. Accurate individualized risk stratification remains elusive, as the interacting contributions of amniotic fluid dynamics, inflammatory status, and microbiological burden are inadequately captured by traditional statistical approaches. Methods: We performed a retrospective, exploratory–predictive analysis of 66 pregnancies complicated by second-trimester PPROM with latency exceeding 14 days. Elastic Net and Random Forest models were trained across six clinically defined predictor domains using a multi-stage block modelling strategy. To address the clinically relevant distinction between antenatal and postnatal information, results are reported separately for Model A—comprising exclusively antenatal predictors available during expectant management (gestational age at PPROM, latency, amniotic fluid trajectory, inflammatory status, vaginal microbiome at admission)—and Model B, which additionally incorporates postnatal variables and characterizes the full mechanistic perinatal risk trajectory. Binary and ordinal outcomes included DLS, PH, BPD, intraventricular hemorrhage (IVH), and neonatal death. Pairwise interaction models were additionally computed to identify cross-domain risk constellations. Results: Distinct predictor architectures emerged per outcome. Pulmonary hypoplasia was most strongly associated with temporal features of oligohydramnios—particularly the persistence and timing of SDP < 1 cm—rather than isolated measurements. For DLS, the antenatal model (Model A) achieved AUC 0.776, driven by gestational maturity and inflammatory status; surfactant administration—a postnatal variable reflecting therapeutic response rather than an antenatal risk factor—dominated only the mechanistic Model B. Neonatal death was driven by a combined profile of respiratory support burden, amniotic fluid persistence, and co-morbidity. IVH showed consistently high ordinal predictability (accuracy 0.863), with amniotic fluid dynamics and microbiological burden as leading contributors. BPD remained the least linearly separable endpoint across all configurations. Conclusions: Multi-domain machine learning reveals outcome-specific, cross-domain risk architectures following second-trimester PPROM that are invisible to conventional statistical models. Longitudinal amniotic fluid trajectory is the dominant antenatal determinant of structural pulmonary morbidity, while microbiological burden independently shapes neurological risk. These findings support prospective validation of integrated ML-based risk stratification tools for individualized antenatal counselling in this high-risk population. Full article

Environmental taxation constitutes a key instrument of climate policy and plays an increasingly important role in decentralised governance systems. Using Spain as an empirical setting characterised by high fiscal decentralisation and pronounced territorial heterogeneity, we analyse the determinants of regional environmental taxation, accounting for both internal regional conditions and cross-regional policy interaction. Employing spatial panel econometric techniques, we provide robust evidence of spatial interaction and temporal persistence in regional environmental taxation at both the intensive and extensive margins. We also find that regional environmental taxation depends not only on domestic economic, institutional, and political characteristics, but also on those of neighbouring regions. These patterns are consistent with key theoretical mechanisms in fiscal federalism and public economics, including tax competition, yardstick competition, the double dividend hypothesis, NIMBY-type responses, and development–environment dynamics. Fur-ther analysis at the intensive margin reveals adjustment patterns consistent primarily with upward dynamics, although some evidence of downward responses is also found. In particular, upward adjustments appear to be more systematic, while downward responses are limited to regions with relatively lower environmental taxation. This asymmetry sug-gests that competitive pressures do not operate uniformly across jurisdictions. From a sustainability and governance perspective, the findings show that environmental tax policies in decentralised systems are shaped by strategic inter-regional interdependence, influencing the trajectories of regional sustainability transitions rather than reflecting isolated policy choices. Full article

Venous thromboembolism (VTE) significantly impacts lung adenocarcinoma outcomes, yet current predictive tools lack precision. We investigated plasma extracellular vesicle (EV) mRNA as a liquid biopsy source to identify a pro-thrombotic molecular profile in VTE patients. Within a prospective cohort of 260 patients, we performed a retrospective nested case–control study, matching 10 VTE cases with 11 thrombosis-free controls. Plasma EV-RNA was analyzed via high-throughput sequencing. Differentially expressed genes (DEGs) were integrated with functional enrichment and explored across public non-cancer VTE datasets, buffy coat samples, and cell lines. RNA-seq identified 483 DEGs within the VTE patient EV compartment, predominantly linked to neutrophil degranulation (NETosis), inflammation, and coagulation. We identified a set of EV-associated candidate genes (SELP, ELANE, MYL9, DNASE1L3) distinguishing cancer-associated thrombosis from non-malignant VTE, along with transcripts (TFPI, FCGR2A) selectively enriched within the EV compartment relative to circulating blood cells. P-selectin (SELP) was the only significantly increased marker, providing the strongest complementary support at the protein level. This molecular state was detectable prior to the occurrence of VTE. Plasma EVs capture a multicellular mRNA profile, reflecting the systemic immunothrombotic activation in lung adenocarcinoma. Despite sample size limitations, these findings should be considered exploratory and hypothesis-generating, but they suggest the EV-derived mRNA in combination with circulating markers such as SELP may provide a framework for future studies aimed at improving risk stratification. Full article

This study aims to identify, based on a Means-End Chain model, the main linkages among attributes, benefits, and perceived value in specialty coffee. Specialty coffee, recognized for its superior quality and sustainable production practices, has experienced growing demand in Brazil and worldwide, intensifying competition and increasing the need to understand how value is constructed from the consumer’s perspective. A quantitative study was conducted using PLS-SEM to test a model adapted to the specialty coffee context, applied to a sample of 88 respondents. The model was validated and explained 29.4% of the variance in Perceived Value, highlighting the role of Attributes and particularly of Benefits and Consequences as the cognitive link that transforms product characteristics into perceived value. In addition to direct effects, significant indirect effects were identified, indicating that a substantial portion of the impact of attributes occurs through mediation, influencing particular, convenient, and rational benefits before being reflected in perceived value. The findings contribute to a systemic understanding of how elements of the coffee value chain are cognitively connected in consumers’ minds and provide insights for positioning, communication, and differentiation strategies to promote sustainable, high-quality coffees. Full article

Against the backdrop of increasingly stringent environmental regulation and increasing uncertainty in supply chain operations, this study examines how environmental penalties affect corporate supply chain resilience. Using Chinese A-share listed firms from 2009 to 2024, this paper constructs a firm-level panel dataset and employs a two-way fixed-effects model to estimate the relationship between environmental penalty intensity and supply chain resilience. Environmental penalty intensity is measured by the annual penalty amount imposed on each firm, while supply chain resilience is captured through an entropy-weighted index reflecting both resistance and recovery capacities. To alleviate endogeneity concerns, this study further uses an instrumental-variable approach based on the interaction between a firm’s one-year lagged penalty amount and city-level thermal inversion days. The results show that environmental penalties reduce corporate supply chain resilience. This negative effect is heterogeneous across firm characteristics and is partially mediated by reduced operational efficiency and crowded-out R&D investment. This conclusion remains robust after replacing the dependent variable, changing the clustering level of standard errors, and excluding observations from the COVID-19 pandemic period. Mechanism tests suggest that environmental penalties weaken supply chain resilience partly by reducing operational efficiency and crowding out R&D investment. Heterogeneity analysis indicates that the negative effect is more pronounced among young firms, non-high-tech firms, and firms located in regions with lower environmental regulation intensity. This study contributes to the literature by distinguishing environmental penalties from broader environmental regulation and by examining their implications for supply chain resilience. The findings also suggest that environmental enforcement should maintain deterrence while improving transparency, predictability, and targeted compliance guidance. Full article

The energy performance of a building reflects its typical energy use and is influenced by factors such as the building envelope (insulation and windows), system efficiency (particularly for heating, cooling, and domestic hot water), and the integration of renewable energy sources. Improving energy performance helps save energy, boost energy independence and security, lower energy costs, and reduce the need for grid investments. Standardizing energy performance assessments enables benchmarking and comparison of building efficiency, encouraging informed decision-making. In this context, the paper presents a knowledge discovery-driven intelligent decision-making system, designed, developed, and tested to identify the best strategies for prioritizing buildings in the envelope process. The system combines data mining techniques with statistical analysis to precisely rank and thoroughly evaluate low-energy-performance buildings and to develop scenario-based strategies for enveloping the buildings to achieve high energy efficiency (associated with nearly zero-energy buildings) under real-world conditions. Testing of the proposed intelligent decision-making system was conducted using a real building database of approximately 3900 records, uploaded from the Romanian central administration website. Under the highest-performance scenario of the envelope-priority strategy, which includes nearly zero-energy building standards, energy savings exceeded 50% across all categories: 51.70% for healthcare, 53.40% for residential, 60.11% for administrative and office buildings, and 69.92% for educational institutions. Overall, the average savings across all building types were 59.81% (644.86 GWh/year). Full article

Listeria monocytogenes is a ubiquitous Gram-positive bacterium responsible for listeriosis, a foodborne zoonotic disease affecting humans and animals. Although infection in immunocompetent individuals is often asymptomatic or limited to mild self-limiting gastroenteritis, Listeria monocytogenes may cause severe invasive disease in vulnerable groups, including pregnant women, neonates, elderly individuals, and immunocompromised patients. Although the incidence of listeriosis is relatively low compared with many other foodborne pathogens, the high hospitalization and mortality rates associated with clinical cases make this bacterium a major concern for food safety and public health. The evolutionary success of L. monocytogenes reflects the interaction between a conserved core genome and a dynamic accessory genome shaped by horizontal gene transfer (HGT), ecological selection, and expansion of specific clones. Transient intestinal carriage in humans and animals, potentially influenced by gut microbiome composition, creates ecological interfaces where plasmids, transposons, prophages, and integrative conjugative elements contribute to the exchange of antimicrobial resistance determinants, virulence factors, and stress tolerance systems. Virulence diversification is further influenced by the differential distribution of pathogenicity islands such as LIPI-1, LIPI-3, and LIPI-4 across specific clonal lineages. These evolutionary processes occur across interconnected farm, food-production, environmental, and clinical ecosystems consistent with the One Health framework. Advances in whole-genome sequencing have clarified lineage-specific gene flow, expansion of specific clones, and the dynamics of the resistome and mobilome in L. monocytogenes populations. This narrative review aims to synthesize current knowledge on the mobile genetic elements and ecological interfaces that shape horizontal gene transfer in L. monocytogenes. Its novelty lies in integrating antimicrobial resistance, virulence-associated genomic islands, stress adaptation, and gut microbiome-mediated selection within a One Health and metapopulation framework. The main message of this review is that HGT should be interpreted as a context-dependent contributor to L. monocytogenes adaptation, acting together with clonal background, ecological selection, and mobile genetic elements. Full article

Against the backdrop of widening regional disparities and the rapid expansion of digital connectivity, understanding the relationship between new quality productive forces (NQPF) and urban–rural integration requires a systemic and network-based perspective. This study approaches urban–rural integration from a complex adaptive system perspective embedded in dynamic interregional networks. Using panel data from 31 Chinese provinces from 2014 to 2024, we construct composite indices for NQPF and urban–rural integration and combine two-way fixed-effects models, static Spatial Durbin Models (SDM), and dynamic-network two-way fixed-effects spatial-lag specifications. This framework helps examine local associations, network-based spillover patterns, and heterogeneous system responses. The results show that: (1) urban–rural integration exhibits significant spatial clustering, with Moran’s I becoming positive and statistically significant after 2016, reflecting persistent structural imbalances within the regional system; (2) the static SDM results show that NQPF is positively associated with urban–rural integration both locally and through spatial indirect linkages; (3) compared with conventional static geographic matrices, the dynamic network-based spatial weights provide additional information on evolving interregional linkages shaped by economic proximity, digital capability similarity, and factor mobility; and (4) under the dynamic network-based specification, NQPF remains positively associated with network exposure in connected provinces, with heterogeneous patterns across regions. More stable local associations are observed in high-connectivity and eastern regions, while the low-connectivity group and central–western regions appear to benefit more from network-based linkages. These findings suggest that the relationship between NQPF and urban–rural integration is embedded in a spatially connected and network-conditioned regional system. By integrating spatial econometrics with a complex systems perspective, this study provides a complementary framework for understanding regional transformation in the digital era. Full article

High Velocity Oxy-Fuel (HVOF) thermal spraying enables the deposition of dense coatings with low porosity, high hardness, and good fracture resistance. Tungsten carbide–cobalt (WC-Co) coatings are widely used in industrial and aerospace applications due to their excellent wear resistance; however, improving crack resistance and coating–substrate adhesion remains a key challenge. In this study, WC-Co+Ni composite coatings were deposited on ductile cast iron, with emphasis on the role of Ni addition in controlling microstructure development under HVOF conditions. Microstructural characterization was performed using optical, scanning, and transmission electron microscopy (OM, SEM, TEM), while phase composition and chemical analysis were determined by X-ray diffraction (XRD) and energy-dispersive spectroscopy (EDS). The coatings exhibited a dense, low-porosity microstructure composed of fine WC and W₂C carbides embedded in a Co–Ni binder, with locally nanocrystalline regions. XRD analysis confirmed WC and W₂C as the dominant phases, with weak reflections corresponding to the η-phase (Co₆W₆C), indicating local decarburization. The addition of Ni increases the fraction of the transient liquid phase during particle flight, enhancing carbide dissolution and mass transport in the binder, which accelerates decarburization kinetics and promotes η-phase formation. Simultaneously, Ni modifies the binder into a more ductile Co–Ni matrix, reducing the detrimental effect of brittle η-phase on coating integrity. Mechanical and tribological testing (instrumented indentation and scratch testing) demonstrated improved crack resistance, wear resistance, and adhesion. The results show that Ni addition enables process-driven microstructural tailoring of HVOF-sprayed WC-Co coatings, leading to enhanced performance despite the presence of η-phase. Full article

Surface mining represents a significant intervention into the natural environment, negatively affecting air, water, soil and local ecosystems. In cement production, these impacts are closely connected to occupational health and safety risks, particularly in processes involving blasting operations. The aim of the article is to design, implement, and empirically verify an integrated model for assessing occupational and environmental risks in the cement production process, with an emphasis on the surface mining of raw materials stage, which will enable a comprehensive assessment of the interrelationships between risks, increase the accuracy of their evaluation, and support effective decision-making in OSH management and the environmental performance of the enterprise. The research was conducted as a case study using a combination of scientific quantitative methods focused on designing and verifying the integrated IMORM model in the cement industry. The methodological approach included an analysis of the requirements of ISO standards, methodological recommendations of EU-OSHA, comparison of approaches, expert interviews, observation in practice, application of a checklist, point-based method, risk catalogue, synthesis of knowledge, modelling, and verification. The application of an integrated approach to risk management demonstrated higher effectiveness compared to traditional approaches, whereby all unacceptable OSH risks were reduced to an acceptable level after the implementation of measures. In the environmental area, the risk score decreased significantly by 52.9%, and in the OSH area, the risk index decreased by 31%. At the same time, the model’s ability to effectively prioritize measures and identify cross-cutting solutions with a high impact was confirmed. The contribution of the article lies primarily in expanding knowledge in the field of integrated risk management and in proposing a practically applicable model that reflects the requirements of management systems according to the standards ISO 14001, ISO 45001 and ISO 31000. The IMORM model represents a tool applicable to enterprises with a high level of occupational and environmental risks, particularly in the mining and processing industries. The model also supports more comprehensive decision-making in the field of OSH and environmental management and contributes to improving the safety and environmental performance of the enterprise. Full article