Search Results (998)

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

Digestate valorization is essential for sustainable waste management and circular economy strategies, yet large-scale adoption faces technical, economic, and environmental challenges. Beyond waste-to-energy conversion, digestate is a valuable soil amendment, enhancing soil structure and reducing reliance on synthetic fertilizers. However, its agronomic benefits depend on feedstock characteristics, treatment processes, and application methods. This study reviews digestate composition, treatment technologies, regulatory frameworks, and environmental impact assessment through Life Cycle Assessment. It analyzes the influence of functional unit selection and system boundary definitions on Life Cycle Assessment outcomes and the effects of feedstock selection, pretreatment, and post-processing on its environmental footprint and fertilization efficiency. A review of 28 JCR-indexed articles (2018–present) analyzed LCA studies on digestate, focusing on methodologies, system boundaries, and impact categories. The findings indicate that Life Cycle Assessment methodologies vary widely, complicating direct comparisons. Transportation distances, nutrient stability, and post-processing strategies significantly impact greenhouse gas emissions and nutrient retention efficiency. Techniques like solid–liquid separation and composting enhance digestate stability and agronomic performance. Digestate remains a promising alternative to synthetic fertilizers despite market uncertainty and regulatory inconsistencies. Standardized Life Cycle Assessment methodologies and policy incentives are needed to promote its adoption as a sustainable soil amendment within circular economy frameworks. Full article

Background and Aim: Type 2 diabetes (T2D) continues to pose a significant public health challenge worldwide. Among therapeutic options, glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have proven effective in optimizing glycemic control and improving cardiometabolic profiles. Semaglutide, now available in an oral formulation, represents a modern strategy to improve patient adherence while supporting glucose and weight regulation. This study primarily investigated the effects of oral semaglutide on key metabolic indicators and secondary endpoints included cardiovascular risk markers (blood pressure and lipid profile) and patient-reported quality of life (QoL). Study Design and Methods: A longitudinal, prospective observational study was conducted involving patients with T2D across two Italian healthcare facilities. Participants were assessed at baseline (T0) and at three subsequent intervals—6 months (T1), 12 months (T2), and 18 months (T3)—following the initiation of oral semaglutide use. Key Findings: Out of 116 participants enrolled, 97 had complete and analyzable data. Across the 18-month follow-up, significant improvements were observed in glycemic parameters, with a notable reduction in HbA1c levels (T0 vs. T3, p = 0.0028; p ≤ 0.05, statistically significant). Self-reported outcomes showed enhanced quality of life, especially in treatment satisfaction and perceived flexibility (T0 vs. T3, p < 0.001). Conclusions: Daily administration of 14 mg oral semaglutide in individuals with T2D resulted in substantial benefits in glycemic regulation, weight reduction, cardiovascular risk management, and overall patient satisfaction. These findings reinforce its potential role as a sustainable and effective option in long-term diabetes care from both a clinical and public health perspective. Full article

Background: Diabetes mellitus is associated with worse outcomes after cardiac arrest. Hyperglycemia, diabetes treatments and other long-term sequalae may contribute to this association. We sought to determine the acute effect of diabetes on the return of spontaneous circulation (ROSC) and post-arrest cardiac function in a rat cardiac arrest model. Methods: Eighteen male Wistar rats were utilized, and 12 underwent the induction of type II diabetes for 10 weeks through a high-fat diet and the injection of streptozotocin. The carotid artery flow and femoral arterial pressure were measured. Seven minutes of asphyxial cardiac arrest was induced. An external cardiac compression was performed via an automated piston. Post-ROSC, epinephrine was titrated to a mean arterial pressure (MAP) of 70 mmHg. Data was analyzed using the Mann–Whitney test. The significance was set at p ≤ 0.05. Results: The rate of the ROSC was significantly lower in animals with diabetes, 50% compared to 100% in non-diabetics. Additionally, it took significantly longer to achieve the ROSC in diabetics, p = 0.034. In animals who survived, the cardiac function was reduced, as indicated by an increased epinephrine requirement, p = 0.041, and a decreased cardiac output at the end of the experiment, p = 0.017. The lactate, venous and arterial pressures, heart rate and carotid flow did not differ between groups at 2 h. Conclusions: Diabetes negatively affects the survival from cardiac arrest. Here, the critical difference was the rate of the conversion to a life-sustaining rhythm and the achievement of the ROSC. The post-ROSC cardiac function was depressed in diabetic animals. Interventions targeted at improving defibrillation success may be important in diabetics. Full article

Hydrogen production is increasingly vital for global decarbonization but remains a water- and energy-intensive process, especially in arid regions. Despite growing attention to its climate benefits, limited research has addressed the environmental impacts of water sourcing. This study employs a life cycle assessment (LCA) approach to evaluate three water supply strategies for hydrogen production: (1) seawater desalination without brine treatment (BT), (2) desalination with partial BT, and (3) freshwater purification. Scenarios are modeled for the United Arab Emirates (UAE), Australia, and Spain, representing diverse electricity mixes and water stress conditions. Both electrolysis and steam methane reforming (SMR) are evaluated as hydrogen production methods. Results show that desalination scenarios contribute substantially to human health and ecosystem impacts due to high energy use and brine discharge. Although partial BT aims to reduce direct marine discharge impacts, its substantial energy demand can offset these benefits by increasing other environmental burdens, such as marine eutrophication, especially in regions reliant on carbon-intensive electricity grids. Freshwater scenarios offer lower environmental impact overall but raise water availability concerns. Across all regions, feedwater for SMR shows nearly 50% lower impacts than for electrolysis. This study focuses solely on the environmental impacts associated with water sourcing and treatment for hydrogen production, excluding the downstream impacts of the hydrogen generation process itself. This study highlights the trade-offs between water sourcing, brine treatment, and freshwater purification for hydrogen production, offering insights for optimizing sustainable hydrogen systems in water-stressed regions. Full article

Flocculants are indispensable in water and wastewater treatment, enabling the aggregation and removal of suspended particles, colloids, and emulsions. However, the conventional development and application of flocculants rely heavily on empirical methods, which are time-consuming, resource-intensive, and environmentally problematic due to issues such as sludge production and chemical residues. Recent advances in machine learning (ML) have opened transformative avenues for the design, optimization, and intelligent application of flocculants. This review systematically examines the integration of ML into flocculant research, covering algorithmic approaches, data-driven structure–property modeling, high-throughput formulation screening, and smart process control. ML models—including random forests, neural networks, and Gaussian processes—have successfully predicted flocculation performance, guided synthesis optimization, and enabled real-time dosing control. Applications extend to both synthetic and bioflocculants, with ML facilitating strain engineering, fermentation yield prediction, and polymer degradability assessments. Furthermore, the convergence of ML with IoT, digital twins, and life cycle assessment tools has accelerated the transition toward sustainable, adaptive, and low-impact treatment technologies. Despite its potential, challenges remain in data standardization, model interpretability, and real-world implementation. This review concludes by outlining strategic pathways for future research, including the development of open datasets, hybrid physics–ML frameworks, and interdisciplinary collaborations. By leveraging ML, the next generation of flocculant systems can be more effective, environmentally benign, and intelligently controlled, contributing to global water sustainability goals. Full article

Efficient plastic waste end-of-life management is a serious worldwide environmental issue motivated by growing waste production and negative effects of wrongful disposal. This study presents a comparative overview of plastic waste management regimes within the European Union (EU), the United States of America (USA), and Romania, ranked with circular economy goals. By using the United States Environmental Protection Agency (US EPA) Waste Reduction Model (WARM), version 16, the study provides a quantified score to greenhouse gas (GHG) emissions within three large options of management: recycling, energy recovery through combustion, and landfilling. The model setup utilizes region-specific information on legislation, base technology, and recycling efficiency. The outcomes show that recycling always entails net GHG emissions reductions, i.e., −4.49 kg CO_2e/capita/year for EU plastic waste and −20 kg CO_2e/capita/year for USA plastic waste. Combustion and landfilling have positive net emissions from 1.76 to 14.24 kg CO_2e/capita/year. Economic indicators derived from the model also show significant variation: salaries for PET management amounted to USD 2.87 billion in the EU and USD 377 million in the USA, and tax collection was USD 506 million and USD 2.01 billion, respectively. The conclusions highlight the wider environmental and socioeconomic benefits of recycling and reinforce its status as a cornerstone of circular-economy sustainable plastic waste management and a strategic element of national development agendas, with special reference to Romania’s national agenda. Full article

The rising demand for sustainable protein is driving interest in insects as a raw material for advanced food ingredients. This review collates and critically analyses over 300 studies on the conversion of crickets, mealworms, black soldier flies, and other farmed species into powders, protein isolates, oils, and chitosan-rich fibers with targeted techno-functional roles. This survey maps how thermal pre-treatments, blanch–dry–mill routes, enzymatic hydrolysis, and isoelectric solubilization–precipitation preserve or enhance the water- and oil-holding capacity, emulsification, foaming, and gelation, while also mitigating off-flavors, allergenicity, and microbial risks. A meta-analysis shows insect flours can absorb up to 3.2 g of water g⁻¹, stabilize oil-in-water emulsions for 14 days at 4 °C, and form gels with 180 kPa strength, outperforming or matching eggs, soy, or whey in specific applications. Case studies demonstrate a successful incorporation at 5–15% into bakery, meat analogs and dairy alternatives without sensory penalties, and chitin-derived chitosan films extend the bread shelf life by three days. Comparative life-cycle data indicate 45–80% lower greenhouse gas emissions and land use than equivalent animal-derived ingredients. Collectively, the evidence positions insect-based ingredients as versatile, safe, and climate-smart tools to enhance food quality and sustainability, while outlining research gaps in allergen mitigation, consumer acceptance, and regulatory harmonization. Full article

Atrial fibrillation remains the most frequent sustained arrhythmia, particularly in the elderly population, and is associated with increased risks of stroke, heart failure, and reduced quality of life. While catheter ablation is widely used for rhythm control, its efficacy is limited in persistent and long-standing atrial fibrillation. Over the past two decades, minimally invasive surgical strategies have emerged as effective alternatives, aiming to replicate the success of the Cox-Maze procedure while reducing surgical trauma. This overview critically summarizes the current minimally invasive techniques available for atrial fibrillation treatment, including mini-thoracotomy ablation, thoracoscopic ablation, and hybrid procedures such as the convergent approach. These methods offer the potential for durable sinus rhythm restoration by enabling direct visualization, transmural lesion creation, and left atrial appendage exclusion, with lower perioperative morbidity compared to traditional open surgery. The choice of energy source plays a key role in lesion efficacy and safety. Particular attention is given to the technical steps of each procedure, patient selection criteria, and the role of left atrial appendage closure in stroke prevention. Hybrid strategies, which combine epicardial surgical ablation with endocardial catheter-based procedures, have shown encouraging outcomes in patients with refractory or long-standing atrial fibrillation. Despite the steep learning curve, minimally invasive techniques provide significant benefits in terms of recovery time, reduced hospital stay, and fewer complications. As evidence continues to evolve, these approaches represent a key advancement in the surgical management of atrial fibrillation, deserving integration into contemporary treatment algorithms and multidisciplinary heart team planning. Full article

Chilling injury (CI) frequently occurs in postharvest flat peach fruit during cold storage, leading to quality deterioration and a reduced shelf life. Therefore, investigating the key factors involved in alleviating CI and developing effective preservatives are vital scientific issues for the industry. 2,4-Epibrassinolide (EBR) is a crucial endogenous hormone involved in plant response to both biological and environmental stressors. At present, most studies focus on the mechanisms of mitigating CI using a single concentration of EBR treatment, while few studies focus on the effects varying EBR concentrations have on CI. The purpose of this research is to explore the effects of varying concentrations of EBR on the postharvest quality and cold resistance of peach fruit, thereby establishing a basis for refining a technical framework of environmentally sustainable strategies to mitigate postharvest CI. The results show that EBR treatment effectively inhibits the generation of reactive oxygen species (ROS) and malondialdehyde (MDA) by maintaining the activities of antioxidant enzymes such as superoxide dismutase (SOD), peroxidase (POD), and catalase (CAT), thereby delaying the internal browning process of postharvest peaches. In addition, EBR treatment reduced the consumption of total phenolics by inhibiting the activities of polyphenol oxidase (PPO) and phenylalanine ammonia lyase (PAL). Experimental results identify that 5 μmol L⁻¹ EBR treatment emerged as the most effective concentration for maintaining core postharvest quality attributes. It significantly delayed the decrease in firmness, reduced weight loss, effectively inhibited the production of H₂O₂ and O₂⁻·, particularly during the early storage period, strongly restrained the activity of PAL, and maintained lower rot rates and internal browning indexes. While the 15 μmol L⁻¹ EBR treatment enhanced antioxidant activity, increased total phenolic content at certain stages, and maintained higher soluble solids and acid content, its effects on key physical quality parameters, like firmness and weight loss, were less pronounced compared to the 5 μmol L⁻¹ treatment. Full article

The advancement of non-thermal disinfection technologies represents a critical pathway for ensuring food safety, meeting environmental sustainability requirements, and meeting consumer preferences for clean-label products. This study systematically evaluated the combined preservation effect of ultrasonic-assisted slightly acidic electrolyzed water (US+SAEW) on mirror carp fillets during refrigeration. Results demonstrated that US+SAEW exhibited superior antimicrobial efficacy compared to individual US or SAEW, achieving reductions of 0.73, 0.74, and 0.79 log CFU/g in total viable counts (TVC), Aeromonas bacteria, and lactic acid bacteria counts compared to the control, respectively. Furthermore, the combined intervention significantly suppressed microbial proliferation throughout the refrigeration period while simultaneously delaying protein and lipid degradation/oxidation induced by spoilage bacteria, thereby inhibiting the formation of alkaline nitrogenous compounds. Consequently, lower levels of pH, total volatile basic nitrogen (TVB-N), protein carbonyl, and thiobarbituric acid reactive substances (TBARS) were observed in US+SAEW compared to the other treatments. Multimodal characterization through low-field nuclear magnetic resonance (LF-NMR), texture, and color analysis confirmed that US+SAEW effectively preserved quality characteristics, extending the shelf life of mirror carp fillets by four days. This study provides a novel non-thermal preservation strategy that combines microbial safety maintenance with quality retention, offering particular advantages for thermolabile food. Full article

Background and Clinical Significance: Serratus Anterior Muscle Pain Syndrome (SAMPS) is an underdiagnosed cause of anterior chest wall pain, often attributed to myofascial trigger points of the serratus anterior muscle (SAM) or dysfunction of the Long Thoracic Nerve (LTN), leading to significant disability and affecting ipsilateral upper limb movement and quality of life. Current diagnosis relies on exclusion and physical examination, with limited treatment options beyond conservative approaches. This case report presents a novel approach to chronic SAMPS, successfully diagnosed using Sonoguided Digital Palpation (SDP) and treated with ultrasound-guided hydrodissection of the LTN using 5% dextrose in water (D5W) without local anesthetic (LA), in a patient where conventional treatments had failed. Case Presentation: A 72-year-old male presented with a three-year history of persistent left chest pain radiating to the upper back, exacerbated by activity and mimicking cardiac pain. His medical history included two percutaneous coronary interventions. Physical examination revealed tenderness along the anterior axillary line and a positive hyperirritable spot at the mid axillary line at the 5th rib level. SDP was used to visualize the serratus anterior fascia (SAF) and LTN, and to reproduce the patient’s concordant pain by palpating the LTN. Ultrasound-guided hydrodissection of the LTN was then performed using 20–30cc of D5W without LA to separate the nerve from the surrounding tissues, employing a “fascial unzipping” technique. The patient reported immediate pain relief post-procedure, with the pain reducing from 9/10 to 1/10 on the Numeric Rating Scale (NRS), and sustained relief and functional improvement at the 12-month follow-up. Conclusions: Sonoguided Digital Palpation (SDP) of the LTN can serve as a valuable diagnostic adjunct for visualizing and diagnosing SAMPS. Ultrasound-guided hydrodissection of the LTN with D5W without LA may provide a promising and safe treatment option for patients with chronic SAMPS refractory to conservative management, resulting in rapid and sustained pain relief. Further research, including controlled trials, is warranted to evaluate the long-term efficacy and generalizability of these findings and to compare D5W to other injectates. Full article

Background/Objectives: Alectinib, a second-generation tyrosine kinase inhibitor indicated for the treatment of non-small-cell lung cancer (NSCLC), exhibits suboptimal oral bioavailability, primarily attributable to its inherently low aqueous solubility and limited dissolution kinetics. This study aimed to enhance Alectinib’s solubility and therapeutic efficacy by formulating a G4-NH2-PAMAM dendrimer complex. Methods: The complex was prepared using the organic solvent evaporation method and characterized by DSC, FTIR, dynamic light scattering (DLS), and zeta potential measurements. A validated high-performance liquid chromatography (HPLC) method quantified the Alectinib. In vitro drug release studies compared free Alectinib with the G4-NH2-PAMAM dendrimer complex. Cytotoxicity against NSCLC cell line A549 was assessed using MTT assays, clonogenic assay, and scratch-wound assay. Xenograft effect was investigated in the H460 lung cell line. Pharmacokinetic parameters were evaluated in rats using LC–MS/MS. Results: Alectinib exhibited an encapsulation efficiency of 59 ± 5%. In vitro release studies demonstrated sustained drug release at pH 6.8 and faster degradation at pH 2.5. Anticancer activity in vitro showed comparable efficacy to free Alectinib, with 98% migration inhibition. In vivo tumor suppression studies revealed near-complete tumor regression (~100%) after 17 days of treatment, compared to 75% with free Alectinib. Pharmacokinetic analysis indicated enhanced absorption (shorter Tmax), prolonged systemic circulation (longer half-life), and higher bioavailability (increased AUC) for the dendrimer-complexed drug. Conclusions: These findings suggest that the G4-NH2-PAMAM dendrimer system significantly improves Alectinib’s pharmacokinetics and therapeutic potential, making it a promising approach for NSCLC treatment. Full article

It is critical to provide life-sustaining treatment to OHCA patients before ambulance care arrives. However, incorrectly performed resuscitation maneuvers reduce the chances of survival and recovery for the victims. Therefore, we must train regularly and learn how to do it correctly. To facilitate regular chest compression training, this study aims to improve the accuracy of a chest compression evaluation system using posture estimation and to develop a web application. To analyze and enhance accuracy, the YOLOv8 posture estimation was used to examine compression depth, recoil, and tempo, and its accuracy was compared to that of the manikin, which has evaluation systems. We conducted comparative experiments with different camera angles and heights to optimize the accuracy of the evaluation. The experimental results showed that an angle of 30 degrees and a height of 50 cm produced superior accuracy. For web application development, a system has been designed to allow users to upload videos for analysis and obtain appropriate compression parameters. The usability evaluation of the application confirmed its ease of use and accessibility, and positive feedback was obtained. In the conclusion, these findings suggest that optimizing recording conditions significantly improves the accuracy of posture-based chest compression evaluation. Future work will focus on enhancing real-time feedback functionality and improving the user interface of the web application. Full article

Food additives are used to prevent food spoilage and extend its shelf life. However, concerns regarding the potential health implications associated with some synthetic additives have prompted research efforts aimed at identifying natural alternatives, such as plant extracts. Cynara cardunculus L. (cardoon) is known for its antimicrobial and antioxidant properties. The aim of this study was to evaluate the capability of ethanolic food-grade extracts from cultivated cardoon and globe artichoke leaves to preserve poultry breast meat during refrigerated storage. A total of seven treatment groups were tested: one control group (no extract) and six active groups with 0.5%, 1%, and 2% (w/w) of either cultivated cardoon or globe artichoke leaf extracts. Lipid oxidation, moisture, colour, pH, acidity, and microbial growth were assessed in poultry meat samples over 15 days. Both extracts were effective in extending shelf life, up to 11 days, by delaying lipid oxidation and microbial growth. Cardoon extract (1% w/w) displayed superior antimicrobial efficacy, maintaining microbial counts below 5 Log CFU/g meat until day 15, compared to the control. Cultivated cardoon leaf extract proves promising as a natural antimicrobial and antioxidant, extending the shelf life of poultry meat. This presents an opportunity to maintain the quality of meat products, aligning with consumer preferences for natural ingredients and sustainable practices. Full article