Search Results (27,200)

Anxiety and depression are common comorbidities in patients with chronic obstructive pulmonary disease (COPD), which can contribute to increased morbidity, reduced quality of life, and worse clinical outcomes. Nevertheless, these psychological conditions remain largely overlooked. This narrative review includes studies published between 1983 and 2025 to synthesise the current evidence on the risk factors, clinical impacts, and therapeutic strategies for these comorbidities. While the exact mechanisms leading to their increased prevalence are not fully understood, growing evidence implicates a combination of biological (e.g., systemic inflammation), social (e.g., isolation and stigma), and behavioural (e.g., smoking and inactivity) factors. Despite current guidelines recommending the identification and management of these comorbidities in COPD, they are not currently included in COPD assessments. Undetected and unmanaged anxiety and depression have serious consequences, including poor self-management, non-adherence to medications, increased risk of exacerbation and hospitalisations, and even mortality; thus, there is a need to incorporate screening as part of COPD assessments. There is robust evidence showing that pulmonary rehabilitation, a core non-pharmacological intervention, can improve mood symptoms, enhance functional capacity, and foster psychosocial resilience. Psychological therapies such as cognitive behavioural therapy (CBT), mindfulness-based approaches, and supportive counselling have also demonstrated value in reducing emotional distress and improving coping mechanisms. Pharmacological therapies, particularly selective serotonin reuptake inhibitors (SSRIs) and serotonin–norepinephrine reuptake inhibitors (SNRIs), are commonly prescribed in moderate to severe cases or when non-pharmacological approaches prove inadequate. However, the evidence for their efficacy in COPD populations is mixed, with concerns about adverse respiratory outcomes and high discontinuation rates due to side effects. There are also barriers to optimal care, including underdiagnosis, a lack of screening protocols, limited provider training, stigma, and fragmented multidisciplinary coordination. A multidisciplinary, biopsychosocial approach is essential to ensure early identification, integrated care, and improved outcomes for patients with COPD. Full article

Fibromyalgia has unclear etiopathogenesis, no curative treatment, and a severe impact on the quality of life. Gratitude practices have been shown to enhance the quality of life in chronic diseases. This systematic review, performed by searching five electronic databases, following the PRISMA guidelines, is the first aiming to evaluate the impact of gratitude in fibromyalgia. Data from eligible studies was extracted and a narrative synthesis was performed. Six articles (four observational studies and two randomized clinical trials) were included. Higher levels of gratitude are associated with reduced symptom severity, an enhanced quality of life, improved well-being, and the improvement of pain-related outcomes in fibromyalgia patients. Gratitude is related to reduced stress, anxiety, and depression; better sleep patterns; and less functional impairment in FM patients. Higher levels of gratitude contribute to a better quality of life, general well-being, and higher functioning capacity in fibromyalgia patients. Based on the results gathered in this systematic review, we propose that gratitude should be investigated as a therapeutic adjuvant in the management of fibromyalgia. Full article

The literature has shown extensive interest in exploring the factors of subjective well-being (SWB). However, most research has conducted cross-sectional analysis of the built environment (BE), commute, and SWB, and little is known about gender differences in their connections. Based on two periods of survey data of 4297 respondents from China, the study performs a cross-sectional and longitudinal examination of whether the BE and commute have effects on SWB, and how the effects differ between men and women. The results reveal that BE features, including destination accessibility and residential density, significantly affect SWB, with stronger impacts observed among men. Men benefit more from greater accessibility and are more negatively affected by higher residential density than women. In contrast, commute mode and duration influence SWB in similar ways for both genders. A shift from nonactive to active commuting improves well-being for men and women alike. Furthermore, certain life events produce gender-specific effects. For instance, childbirth increases SWB for men but decreases it for women. These findings highlight the importance of gender-sensitive planning in building inclusive urban and transportation environments that enhance population well-being. Full article

Obstructive sleep apnea syndrome (OSAS) is a prevalent disorder with significant systemic and oral health consequences. This narrative review synthesizes the current knowledge on the interplay between dental health and sleep apnea, highlighting the expanding role of dentists in the screening, early detection, and management of OSAS. Validated questionnaires, anatomical assessments, and anthropometric measurements have enhanced dentists’ capacity for early screening. However, knowledge and training gaps remain, particularly in low- and middle-income countries. Dentists are uniquely positioned to identify anatomical and oral risk factors, facilitate referrals for diagnosis, and provide therapeutic interventions such as oral appliance therapy. Interdisciplinary collaboration between dental and medical professionals is essential to improve early detection, treatment outcomes, and patient quality of life. Enhancing education, standardizing protocols, and integrating dentists into multidisciplinary care pathways are critical steps for advancing the management of sleep apnea. Full article

Pain management in multiple trauma patients presents a complex clinical challenge due to competing priorities such as hemodynamic instability, polypharmacy, coagulopathy, and the urgency of life-saving interventions. In this context, peripheral nerve blocks (PNBs) are increasingly recognized as a valuable asset for their role in managing pain in patients with multiple traumatic injuries. By reducing reliance on systemic opioids, PNBs support effective pain control and facilitate early mobilization, aligning with enhanced recovery principles. This narrative review summarizes current evidence on the use of PNBs in the context of polytrauma, focusing on their analgesic efficacy, integration within multimodal analgesia protocols, and contribution to improved functional outcomes. Despite these advantages, clinical application is limited by specific concerns, including the potential to mask compartment syndrome, the risk of nerve injury or local anesthetic systemic toxicity (LAST), and logistical barriers in acute trauma settings. Emerging directions in the field include the refinement of ultrasound-guided PNB techniques, the expanded use of continuous catheter systems, and the incorporation of fascial plane blocks for anatomically complex or multisite trauma. Parallel efforts are focusing on the development of decision-making algorithms, improved risk stratification tools, and integration into multimodal analgesic pathways. There is also growing emphasis on standardized clinical protocols, simulation-based training, and patient education to enhance safety and consistency in practice. As evidence continues to evolve, the long-term impact of PNBs on functional recovery, quality of life, and healthcare utilization must be further explored. With thoughtful implementation, structured training, and institutional support, PNBs may evolve into a cornerstone of modern trauma analgesia. Full article

(1) Background: Early palliative care (EPC) is increasingly recognized as a key component of comprehensive cancer management, with evidence supporting improvements in quality of life, symptom control, and clinical outcomes in advanced malignancies. (2) Methods: This systematic review followed PRISMA 2020 guidelines and was prospectively registered in PROSPERO (CRD42024623219). We searched PubMed, Embase, and the Cochrane CENTRAL Library for randomized controlled trials (RCTs) evaluating EPC in adults with advanced, incurable, or metastatic cancer. Eligible studies reported on at least one of the following: overall quality of life, symptom burden, or disease progression indicators. (3) Results: Forty-one RCTs met inclusion criteria. Despite heterogeneity in timing and structure, EPC consistently improved quality of life and reduced symptom burden in advanced cancer patients, with 32 trials demonstrating significant clinical benefit. Some studies also reported slowed disease progression. However, several RCTs showed no significant effects, highlighting variation in outcomes, possible subgroup effects, and challenges in implementation. Definitions and delivery of EPC varied widely, particularly in timing, frequency, and integration into oncology care. (4) Conclusions: These findings support the integration of EPC alongside disease-directed treatments, challenging the misconception that palliative care is only appropriate at the end of life and reinforcing its role early in the cancer care continuum. Full article

The increasing prevalence of chronic metabolic diseases poses a significant challenge in the modern world, impacting healthcare systems and individual life expectancy. The World Health Organization (WHO) recommends that older adults (65+ years) engage in 150–300 min of moderate-intensity or 75–150 min of vigorous-intensity physical activity, alongside muscle-strengthening and balance-training exercises at least twice a week. However, nearly one-third of the adult population (31%) is physically inactive, which increases the risk of developing obesity, type 2 diabetes, cardiovascular diseases, hypertension, and psychological issues. Physical activity in the form of aerobic exercise, resistance training, or a combination of both is effective in preventing and managing these metabolic diseases. In this review, we explored the effects of exercise training, especially on respiratory and pulmonary factors, including oxygen consumption, pulmonary ventilation, and blood gas analyses among adults. During exercise, oxygen consumption can increase up to 15-fold (from a resting rate of ~250 mL/min) to meet heightened metabolic demands, enhancing tidal volume and pulmonary efficiency. During exercise, the increased energy demand of skeletal muscle leads to increases in tidal volume and pulmonary function, while blood gases play a key role in maintaining the pH of the blood. In this review, we explored the influence of age, body composition (BMI and obesity), lifestyle factors (smoking and alcohol use), and comorbidities (diabetes, hypertension, neurodegenerative disorders) in the modulation of these physiological responses. We underscored exercise as a potent non-pharmacological intervention for improving cardiopulmonary health and mitigating the progression of metabolic diseases in aging populations. Full article

Background and Objectives: Breast reconstruction after mastectomy has been shown to significantly improve psychosocial wellbeing and quality of life. Enhanced Recovery After Surgery (ERAS) protocols, especially those tailored to breast reconstruction, have revolutionized recovery by reducing complications, pain, opioid use, and hospital stay while improving patient satisfaction. The purpose of this narrative review was to present existing practices and supporting evidence within current ERAS protocols, as well as propose a modern ERAS framework centered around enhancing the patient experience following breast reconstruction. Methods: A focused literature search was conducted to identify studies investigating emerging approaches to patient care and surgical techniques adopted as part of a broader ERAS workflow Results: Some recent innovations include digital ERAS tracking, robot-assisted techniques, neurotization, and closed incision negative pressure therapy (ciNPT). These innovations show promise in reducing morbidity following reconstruction and may greatly improve sensory and functional outcomes. These advancements also reflect a shift toward more holistic, patient-centered care, extending beyond immediate clinical needs to address long-term wellbeing through psychosocial support and patient-reported outcome measures. Incorporating tools that validate patient perspectives helps guide interventions to optimize satisfaction and recovery. Conclusions: Future research should aim to standardize ERAS protocols by incorporating evidence-based practices, reinforcing breast reconstruction as a patient-centered, evidence-driven process that is focused on comprehensive recovery and improved quality of life. Full article

End-of-life (EoL) continuous glass fibre-reinforced polyamide 6 composites (cGF/PA6) are commonly recycled by shredding and milling, followed by injection moulding, often resulting in lower mechanical properties of second-generation products, primarily due to fibre length reduction. This study investigates the thermomechanical reprocessing of cGF/PA6 laminates via compression moulding, aiming to retain maximum mechanical performance by preserving the fibre length. Two types of 2/2 twill glass fibre-reinforced anionically polymerised polyamide 6 laminates (cGF/APA6), with either a reactive sizing agent (RS) or a non-reactive sizing agent (nRS), were reprocessed at two different temperatures, i.e., at 180 °C (between the glass transition temperature (Tg) and the melting temperature (Tm) of PA6) and 230 °C (above the melting temperature (Tm) of PA6). The influence of reprocessing on matrix crystallinity, thermomechanical properties, microstructure, and flexural performance was investigated. The results revealed that reprocessing at both temperatures led to an improvement in matrix crystallinity, retention of the desirable α-crystalline phases, and an elevated T_g (glass transition temperature) in both reprocessed laminates. Additionally, reprocessing at 180 °C maintained the flexural performance in both, whereas reprocessing at 230 °C led to nearly 20% improvement in flexural strength for the RS laminate. The microstructural analysis of the failed flexural specimens showed matrix-coated fibre surfaces, highlighting retained fibre–matrix adhesion. Overall, the results offer insights into the potential of compression moulding as a viable alternative for recycling cGF/APA6 laminates. Full article

Urbanization and the rapid growth of e-commerce have significantly increased delivery volumes in cities, creating challenges in terms of cost, efficiency, and sustainability in last-mile delivery (LMD). To address these challenges, this paper proposes an innovative methodological framework for selecting optimal delivery strategies in urban environments, grounded in the principles of collaboration. The framework integrates an Extended FullEx method, developed to calculate criteria weights while accounting for expert reputation based on education and experience, with the MARCOS multi-criteria decision-making (MCDM) method used to rank delivery strategies. The Extended FullEx method proposed in this paper differs from the original FullEx by providing two improvements. The first concerns the introduction of the normalization procedure in the calculation of experts’ reputations, while the second addresses the different scoring of educational degrees, providing a more precise mathematical basis for the process. Four collaborative delivery strategies are evaluated against twelve sustainability-related criteria identified through an extensive literature review. The proposed framework is applied to a real-life case study in Novi Sad, Republic of Serbia. Results indicate that the most suitable delivery strategy is a hybrid model that combines the use of a consolidation center with smaller urban delivery hubs, providing practical insights for enhancing the sustainability and efficiency of urban delivery. This study contributes both methodologically, by advancing MCDM techniques, and practically, by offering decision-makers a comprehensive tool that integrates subjective expert knowledge and objective criteria assessment in the selection of sustainable LMD solutions. Full article

Flash floods, exacerbated by climate change and land use alterations, are among the most destructive natural hazards globally, leading to significant damage and loss of life. In this context, the Flash Flood Potential Index (FFPI), which is a terrain and land surface-based model, and Google Earth Engine (GEE) were used to assess flood-prone zones across North Macedonia’s watersheds. The presented GEE-based assessment was accomplished by a custom script that automates the FFPI calculation process by integrating key factors derived from publicly available sources. These factors, which define susceptibility to torrential floods, include slope (Copernicus GLO-30 DEM), land cover (Copernicus GLO-30 DEM), soil type (SoilGrids), vegetation (ESA World Cover), and erodibility (CHIRPS). The spatial distribution of average FFPI values across 1396 small catchments (10–100 km²) revealed that a total of 45.4% of the area exhibited high to very high susceptibility, with notable spatial variability. The CHIRPS rainfall data (2000–2024) that combines satellite imagery and in situ measurements was used to estimate peak 24 h runoff and discharge. To improve the accuracy of CHIRPS, the data were adjusted by 30–50% to align with meteorological station records, along with normalized FFPI values as runoff coefficients. Validation against 328 historical river flood and flash flood records confirmed that 73.2% of events aligned with moderate to very high flash flood susceptibility catchments, underscoring the model’s reliability. Thus, the presented cloud-based scenario highlights the potential of the GEE’s efficacy in scalability and robustness for flash flood modeling and regional risk management at national scale. Full article

Cyclin-dependent kinase (CDK)4/6 inhibitors have become a key component of adjuvant treatment for patients with hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2−) early breast cancer who are at high risk of recurrence. The addition of abemaciclib and ribociclib to standard endocrine therapy has demonstrated clinically meaningful improvements in invasive disease-free survival, supported by the monarchE and NATALEE trials, respectively. With expansion of patient eligibility for CDK4/6 inhibitors, multidisciplinary coordination among medical oncologists, surgeons, nurses, pharmacists, and other health care providers is critical to optimizing patient identification, monitoring, and management of adverse events. This expert guidance document provides practical recommendations for implementing adjuvant CDK4/6 inhibitor therapy in routine clinical practice, incorporating insights from multiple specialties and with patient advocacy representation. Key considerations include patient selection based on clinical trial data, treatment duration, dosing schedules, adverse event profiles, monitoring requirements, drug–drug interactions, and patient-specific factors such as tolerability, cost, and quality of life. This guidance aims to support Canadian clinicians in effectively integrating CDK4/6 inhibitors into clinical practice, ensuring optimal patient outcomes through a multidisciplinary and patient-centric approach. Full article

Prostate cancer (PCa) is the second most frequently diagnosed malignancy in men worldwide. Although traditionally considered a disease of older men, the incidence of early-onset PCa (diagnosis < 55 years) is steadily rising. Advances in screening and therapy have significantly improved survival, creating a growing cohort of younger survivors for whom post-treatment quality of life—notably reproductive function—is paramount. Curative treatments such as radical prostatectomy, pelvic radiotherapy, androgen-deprivation therapy (ADT), and chemotherapy often cause irreversible infertility via multiple mechanisms, including surgical disruption of the ejaculatory tract, endocrine suppression of spermatogenesis, direct gonadotoxic injury to the testes, and oxidative sperm DNA damage. Despite these risks, fertility preservation is frequently overlooked in pre-treatment counseling, leaving many patients unaware of their options. This narrative review synthesizes current evidence on how PCa therapies impact male fertility, elucidates the molecular and physiological mechanisms of iatrogenic infertility, and evaluates both established and emerging strategies for fertility preservation and restoration. Key interventions covered include sperm cryopreservation, microsurgical testicular sperm extraction (TESE), and assisted reproductive technologies (ART). Psychosocial factors influencing decision-making, novel biomarkers predictive of post-treatment spermatogenic recovery, and long-term offspring outcomes are also examined. The review underscores the urgent need for timely, multidisciplinary fertility consultation as a routine component of PCa care. As PCa increasingly affects men in their reproductive years, proactively integrating preservation into standard oncologic practice should become a standard survivorship priority. Full article

Agave species are plants with great economic value and multiple possibilities of use as ornamentals, medicinal plants, and fibers, as well as being significant sources of bioethanol. However, their long life cycles hinder their conventional breeding. Therefore, biotechnology tools are the most effective means for clonal propagation and genetic improvement. In vitro micropropagation of A. sisalana via axillary shoot proliferation from bulbil explants was attained using Murashige and Skoog medium (MS) supplemented with cytokinins (CKs), such as 6-benzyladenine (BA), kinetin (KIN), or thidiazuron (TDZ). The optimum significant shoot proliferation (14.67 shoots/explant) was achieved on 1.0 mg L⁻¹ TDZ. The carry-over effect of CKs on subsequent rooting could be detected. Control and KIN treatments could enhance the rooting of shoots on shoot proliferation media. The regenerated plantlets were acclimatized directly with 100% survival. To mitigate this carry-over effect, that causes hindering further root growth and development, and promote healthy growth of roots, subculturing shoots onto a CK-free medium is a recommended practice. The shoots induced on all BA treatments, and TDZ at 0.5 and 1.0 mg L⁻¹ could be rooted after two subcultures on CK-free medium, then they were acclimatized with 100% survival. However, the higher concentrations of TDZ inhibited in vitro rooting even after two subcultures on CK-free medium, and the acclimatization percentage was reduced by increasing the TDZ concentration recorded from 10 to 0%. Full article

The stability of nitrogen gas foam hinders its applicability in petroleum applications. Fly ash nanoparticles and clay improve the N₂ foam stability, and flue gas foams provide a cost-effective solution for carbon capture, utilization, and storage (CCUS). This study examines the stability, volume, and bubble structure of foams formed using two anionic surfactants, sodium dodecyl sulfate (SDS) and sodium dodecylbenzene sulfonate (SDBS), along with the cationic surfactant cetyltrimethylammonium bromide (CTAB), selected for their comparable interfacial tension properties. Analysis of foam stability and volume and bubble structure was conducted under different CO₂/N₂ mixtures, with half-life and initial foam volume serving as the evaluation criteria. The impact of fly ash and clay on SDS-N₂ foam was also evaluated. The results showed that foams created with CTAB, SDBS, and SDS exhibit the greatest stability in pure nitrogen, attributed to low solubility in water and limited gas diffusion. SDS showed the highest foam strength attributable to its comparatively low surface tension. The addition of fly ash and clay significantly improved foam stability by migrating to the gas–liquid interface, creating a protective barrier that reduced drainage. Both nano fly ash and clay improved the half-life of nitrogen foam by 11.25 times and increased the foam volume, with optimal concentrations identified as 5.0 wt% for fly ash and 3.0 wt% for clay. This research emphasizes the importance of fly ash nanoparticles in stabilizing foams, therefore optimizing a foam system for enhanced oil recovery (EOR). Full article