Search Results (13,628)

In the Republic of Korea, the problems of low birth rate and population aging are accelerating population decline at the regional level, leading to the phenomena of local extinction and urban shrinkage. These phenomena, coupled with the projected nationwide population decline, pose a fundamental threat to the sustainability of essential infrastructure such as urban parks. The conventional growth-oriented paradigm of urban planning has shown clear limitations in quantitatively forecasting future demand, constraining proactive management strategies for the era of population decline. To address this gap, this study develops a policy-decision-support framework that integrates long-term population projections, grid-based population data, the DEGURBA urban classification system—a global standard for delineating urban and rural areas— and network-based accessibility analysis. For the entire Republic of Korea, we (1) constructed a 1 km resolution time-series population dataset for 2022–2072; (2) applied DEGURBA to quantify transitions among urban, semi-urban, and rural types; and (3) assessed changes in potential user populations within the defined service catchments. The results indicate that while population concentration in the Seoul Capital Area persists, under the low-variant scenario, a projected average decline of 40% in potential user populations by 2072 will lead to significant functional changes, with 53.6% of municipalities nationwide transitioning to “semi-urban” or “rural” areas. This spatial shift is projected to decrease the proportion of urban parks located in “urban” areas from 83.3% to 75.0%, while the total potential user population is expected to plummet from approximately 44.4 million to 25.8 million, a 42.0% reduction. This study underscores the need for urban park policy to move beyond quantitative expansion and toward quality-oriented management based on selection and concentration. By uniquely integrating long-term demographic scenarios, the Degree of Urbanization (DEGURBA), and spatial accessibility analysis, this study provides a foundational scientific basis for forecasting future demand and supports the formulation of sustainable, data-driven strategies for urban park restructuring under conditions of demographic change. Full article

Background and Aims: Severe acute respiratory distress syndrome (ARDS) in patients with long COVID remains associated with extremely high mortality and significant long-term sequelae. Non-invasive ventilatory strategies such as continuous positive airway pressure (CPAP) and high-flow nasal cannula (HFNC) are widely used before endotracheal intubation (ETI). Still, their comparative effectiveness in this population is not well established. Understanding survival outcomes and sequelae can help refine treatment strategies for this high-risk group. This study aimed to evaluate outcomes, sequelae, and treatment strategies in long COVID patients with severe ARDS, focusing on non-invasive ventilatory support before ETI. Materials and Methods: A retrospective cohort analysis was performed using a study comparing severe ARDS patients with and without COVID-19. The inclusion criterion was a Horovitz quotient (PaO₂/FiO₂) < 50 mmHg. Results: The study included a total of 59 patients diagnosed with long COVID-19 ARDS, with a mortality rate of 85%. A significant proportion of the patient population was male, accounting for 75%. The highest survival rate was observed among patients who initially received CPAP support, with a survival rate of 23.08%, in contrast to those treated solely with HFNC or those who alternated between HFNC and CPAP. Among patients who required endotracheal intubation and subsequent mechanical ventilation, survival rates were 40% for those who had previously received CPAP, 10% for those treated with alternating HFNC and CPAP, and 0% for those managed exclusively with HFNC before ETI. Survivors often exhibited sequelae, such as impaired pulmonary function, persistent dyspnea, and diminished physical performance. Conclusions: Patients with long COVID who develop severe ARDS (PaO₂/FiO₂ < 50 mmHg) face exceptionally high ICU mortality, with outcomes determined mainly by age, comorbidities, and profound hypoxemia. Although CPAP showed a trend toward improved survival, the data do not establish superiority and should be regarded as hypothesis-generating. Rather, they highlight the complexity of managing this underrepresented subgroup and underscore the need for larger, multicenter studies with broader inclusion criteria to confirm or refute these preliminary observations. Full article

Recent advances in molecular biology have led to the development of RNA-based therapeutics, offering significant promise for treating various eye diseases. Current RNA therapeutics include RNA aptamers, antisense oligonucleotides (ASOs), small interfering RNA (siRNA), and messenger RNA (mRNA) that can target specific genetic and molecular pathways involved in eye disorders. In addition to their potential in therapy, RNA technologies have also provided tools for mechanistic studies to improve the understanding of eye diseases, expanding the possibilities of RNA-based treatments. Despite the utility of RNA in studying eye disease mechanisms and its potential in disease treatment, only a few RNA-based therapies have been approved for posterior eye diseases. This paper reviews RNA interference and related ocular delivery and posterior eye diseases, focusing on the use of RNA aptamers, siRNA, short hairpin RNA (shRNA), and microRNA (miRNA). Approaches using RNA to advance our understanding of eye diseases and disease treatments, particularly in the posterior segment of the eye, are discussed. It is concluded that RNA therapeutics offer a novel approach to treating a variety of eye diseases by targeting their molecular causes. siRNA, shRNA, miRNA, and ASO can directly silence disease-driving genes, while RNA aptamers bind to specific targets. Although many RNA-based therapies are still in experimental stages, they hold promise for conditions such as age-related macular degeneration (AMD), diabetic macular edema (DME), glaucoma, and inherited retinal disorders. Effective delivery methods and long-term safety are key challenges that need to be addressed for these treatments to become widely available. Full article

Background/Objectives: Dyslipidemia is one of the major problems of long-term management in people living with human immunodeficiency virus (HIV) (PLH) as a risk factor for cardiovascular diseases. Lipoprotein lipase (LPL) is anchored on the surface of the capillary endothelial cells and plays a pivotal role in triglyceride metabolism by catabolizing dietary chylomicrons and very low-density lipoprotein synthesized in the liver. However, the details of the mechanisms in the era of integrase strand transfer inhibitor-based antiretroviral therapy have not yet been clarified. Methods: This study was a cross-sectional, single-center, non-interventional study evaluating the underlying factors associated with dyslipidemia, insulin resistance or secretion, and changes in the body composition of PLH. Results: Among PLH (n = 48), lower LPL (<60.8 ng/mL) and older age independently predicted antilipemic drug (ALD) necessity. A comparison of ALD-naïve PLH (n = 33) and age- and sex-matched non-HIV controls (n = 33) showed that PLH were significantly associated with lower high-density lipoprotein cholesterol (HDL-C) and higher HOMA-β. LPL was also the independent predictor of HDL-C < 40 mg/dL in PLH (adjusted odds ratio = 0.901, p = 0.044). Furthermore, LPL < 65.3 ng/mL predicted HDL-C < 40 mg/dL with 100% sensitivity and 60.9% specificity. Low levels of HIV-RNA were detected in the high HOMA-β group. Conclusions: In Japanese individuals, compared to non-HIV controls, PLH has low HDL-C and LPL. The measurement of LPL may confer the risk assessment and decision-making with relevance to ALD in PLH. Additionally, the effectiveness of HIV antiviral therapy and glucose tolerance may interact with each other. Full article

Objectives: Preterm infants are at higher risk for developmental delays (DDs) and long-term complications compared with term infants. With the high prevalence of preterm births in Arabic-speaking countries, an Arabic-language screening tool is crucial. The aim of the study is to examine the feasibility of utilizing an Arabic version of the Ages and Stages Questionnaire, Third Edition (A-ASQ-3), at 4 months corrected age (CA). Methods: Infants born at or after 28 weeks of gestational age were recruited in this longitudinal study. A total of 48 infants underwent the developmental assessment at 4 months CA using the A-ASQ-3. The primary outcome was identifying the infants at risk for DDs. Descriptive statistics, t-tests, and Firth’s logistic regression were used for analysis. Results: Of the 48 infants, 37 (77.1%) had a DD at in least one of the five A-ASQ-3 domains at 4-months CA. None of the risk factors assessed in this study were associated with a high risk of DDs among preterm infants. Conclusions: The A-ASQ-3 is a feasible tool for identifying infants at risk for DDs at 4 months CA. This finding underscores the need for early screening and tailored intervention programs for preterm infants in Saudi Arabia. The A-ASQ-3 can help identify infants at high risk of DDs and enable prompt referral to healthcare providers. Full article

The surface properties of composite resin restorative materials are critical for the esthetics and longevity of restorations. This in vitro study evaluated the microhardness change and surface roughness change in four resin composites recommended for anterior restorations after two aging simulations: thermal cycling (10,000 cycles) and one year of water storage. Ten specimens (n = 10) were prepared for each material. After baseline measurements, samples were subjected to one of the aging procedures, and surface properties were reassessed. For microhardness change (∆H), significant differences were observed among materials under both thermal cycling (p = 0.001) and water storage (p = 0.001). Omnichroma–thermal cycling showed a greater decrease than G-ænial Anterior (p = 0.028) and Clearfil Majesty ES-2 (p = 0.001), while Optishade–thermal cycling decreased more than Clearfil Majesty ES-2 (p = 0.015). In water storage, Omnichroma exhibited a greater decrease than Optishade (p = 0.042) and Clearfil Majesty ES-2 (p = 0.001), and G-ænial Anterior decreased more than Clearfil Majesty ES-2 (p = 0.026). Optishade and Clearfil Majesty ES-2 showed significantly greater decreases after thermal cycling than water storage, while Omnichroma and G-ænial Anterior showed no difference. For the change in surface roughness (∆R), significant differences were also found (p = 0.001). In thermal cycling, Optishade exhibited the lowest increase, while G-ænial Anterior showed the highest. In water storage, G-ænial Anterior again had the highest increase, significantly greater than all others (p = 0.001). For all materials, ∆R values were significantly higher after thermal cycling compared with those in water storage (p = 0.001). These results demonstrate that both composite type and aging method influence long-term surface properties. Overall, thermal cycling exerted more detrimental effects than water storage. Full article

Background: Macular edema (ME) secondary to retinal vein occlusion (RVO) is a significant cause of vision impairment. Many patients show suboptimal responses to anti-vascular endothelial growth factor (anti-VEGF) monotherapy, prompting the exploration of alternative treatments. Faricimab is a bispecific antibody that targets VEGF-A and angiopoietin-2. We report 9-month real-world outcomes of switching to faricimab in therapy-resistant RVO-associated ME. Methods: In this retrospective study at a single tertiary center, patients with persistent or recurrent ME despite prior treatments (ranibizumab, aflibercept, or dexamethasone implant) were switched to faricimab. All eyes received a loading phase of four monthly faricimab injections, followed by a treat-and-extend regimen individualized per response. Key outcomes included best-corrected visual acuity (BCVA, logMAR), the central subfield thickness (CST, μm), and the intraretinal fluid (IRF) status on optical coherence tomography, assessed from the baseline (month 0, mo0) through the loading phase (mo1–mo3) and at month 9 (mo9). Results: Nineteen eyes (19 patients, mean age 64.8 years) were analyzed. The median BCVA improved from 0.20 to 0.00 logMAR by month 3 (p < 0.01) and was maintained at month 9. The median CST decreased from 325 μm at the baseline to 285 μm at month 3 (p < 0.01) and remained at 285 μm at month 9. IRF was present in 100% of eyes at the baseline, 26% at month 3, and 26% at month 9 (p < 0.01 for the baseline vs. month 9). Among eyes previously on anti-VEGF therapy (n = 14), the median treatment interval increased from 45.50 days at the baseline to 56.50 days at month 9 (p = 0.01; δ = 0.86). No intraocular inflammation or other adverse events were observed in this cohort over nine months. Conclusions: In this retrospective series, switching to faricimab was associated with improvements in vision and retinal anatomy that were maintained over 9 months; injection intervals were extended in a subset of eyes. These exploratory findings warrant confirmation in larger, controlled studies to define long-term effectiveness, safety, and dosing strategies. Full article

Introduction: The management of neovascular age-related macular degeneration (nAMD) is constrained by diminishing therapeutic options for retina specialists and their patients when the disease reaches its end stages. Methods: Clinical insights emerge from two case narratives in which patients benefitted from discontinuation of anti-VEGF therapy. Results: Long-term management of nAMD with intravitreal injections of agents targeting vascular endothelial growth factor (VEGF) is crucial for slowing progression of the disease and is generally well-tolerated. However, vision often declines as the disease progresses over time, even with treatment. This article presents strategies for aligning therapeutic goals with their expected visual outcome when an eye has reached end-stage disease. It addresses considerations for how and when to stop treatment when vision becomes limited, taking into consideration the visual status of the fellow eye and incorporating input from low vision specialists who can better assess best-corrected visual acuity (BCVA) and optimize the visual function of patients. We also acknowledge the potential benefits of switching either the dose or the agent that targets VEGF to alter the long-term visual outcome of treatment. Finally, we discuss the importance of taking into consideration related manifestations of the disease, such as macular scarring, geographic atrophy, or other retinal or optic nerve diseases which may limit vision and thus the utility of continued nAMD treatment. Conclusions: Building a strong patient–physician relationship is essential for navigating the shared decision-making process of when to stop treatment for nAMD. Full article

Artificial intelligence (AI) is profoundly transforming heritage tourism through the incorporation of technological solutions that reconfigure the ways in which cultural heritage is conserved, interpreted, and experienced. This article presents a critical and systematic review of current AI applications in this field, with a special focus on their impact on destination management, the personalization of tourist experiences, universal accessibility, and the preservation of both tangible and intangible assets. Based on an analysis of the scientific literature and international use cases, key technologies such as machine learning, computer vision, generative models, and recommendation systems are identified. These tools enable everything from the virtual reconstruction of historical sites to the development of intelligent cultural assistants and adaptive tours, improving the visitor experience and promoting inclusion. This study also examines the main ethical, technical, and epistemological challenges associated with this transformation, including algorithmic surveillance, data protection, interoperability between platforms, the digital divide, and the reconfiguration of heritage knowledge production processes. In conclusion, this study argues that AI, when implemented in accordance with principles of responsibility, sustainability, and cultural sensitivity, can serve as a strategic instrument for ensuring the accessibility, representativeness, and social relevance of cultural heritage in the digital age. However, its effective integration necessitates the development of sector-specific ethical frameworks, inclusive governance models, and sustainable technological implementation strategies that promote equity, community participation, and long-term viability. Furthermore, this article highlights the need for empirical research to assess the actual impact of these technologies and for the creation of indicators to evaluate their effectiveness, fairness, and contribution to the Sustainable Development Goals. Full article

Air pollution is associated with many adverse health outcomes, including kidney diseases. Kidney diseases, especially chronic kidney disease, are a significant public health issue globally. The burden of kidney disease is expected to rise due to population aging and the growing prevalence of diabetes and hypertension. End-stage kidney disease is associated with significant healthcare costs, morbidity, and mortality. Long-term exposure to air pollution was associated with increased risk for chronic kidney disease progression to kidney replacement therapy. Evidence on the effect of short-term exposure to air pollution on renal function is rather limited. Kidney transplant patients are likely to be even more susceptible to detrimental effects of air pollutants. Exposure to air pollution results in a higher risk for delayed graft function, acute rejection, and mortality. In this review we would like to summarize the state of knowledge on the influence of air pollution on outcomes in end-stage kidney failure and kidney transplantation. Full article

This work presents an innovative approach to enhancing the performance of concrete with reclaimed asphalt pavement (RAP) aggregates using titanium dioxide (TiO₂) nanoparticles. Traditional limestone coarse aggregates were partially replaced with 30% and 50% RAP aggregates; a subset of mixtures containing RAP aggregates was treated with TiO₂ nanoparticles. The rheological, mechanical, and long-term properties of concrete, along with changes in its chemical composition following the addition of RAP and TiO₂, were evaluated. Results revealed that using 30% and 50% RAP in concrete mixtures reduced their compressive strength by 18% and 27%, respectively. However, using TiO₂ in those mixtures enhanced their compressive strength by 8.7% and 6.3%. Moreover, concrete with 50% RAP exhibited an 85% increase in water absorption (the highest among all mixtures) compared to the control. TiO₂ treatment was most beneficial in the 30% RAP mixture, reducing its water absorption by 32.5% compared to its untreated counterpart. Additionally, the 30% RAP mixture treated with TiO₂ showed the highest resistance to sulfates among modified mixtures, as its compressive strength decreased by 10.4% compared to a decrease of 23% in the strength of the untreated 30% RAP mixture. Statistical analysis using single-factor ANOVA showed that integrating RAP aggregates with or without the presence of TiO₂ particles would significantly affect the concrete properties in terms of their population means. The t-test analysis, on the other hand, proved sufficient evidence that the mean values of the 30% RAP mixture treated with TiO₂ would not differ significantly from the control in terms of its slump and water absorption properties. The chemical structure analysis revealed an increase in the Si-O-Si and Si-O functional groups when using TiO₂ in RAP mixtures, suggesting improved hydration activity and accelerated C-S-H formation in the treated RAP mixtures. Moreover, distinct C-H peaks were witnessed in concrete with untreated RAP aggregates, resulting from the aged asphalt coating on the RAP, which weakened the bond between the RAP and the cementitious matrix. Full article

Background and Objectives: Ixekizumab is a human monoclonal antibody targeting interleukin-17A, approved for the treatment of moderate-to-severe plaque psoriasis. Given its demonstrated efficacy and safety in clinical trials, this study aimed to evaluate the real-world drug survival of Ixekizumab and identify clinical predictors of treatment discontinuation. Materials and Methods: A retrospective, observational, hospital-based study was conducted in the Department of Dermatology at the Central University Hospital of Asturias (HUCA). Patients with moderate-to-severe plaque psoriasis who initiated treatment with Ixekizumab (Taltz^®) between 8 June 2017 and 10 October 2024, were included. Demographic data, comorbidities, age at disease onset, family history, PASI score, and previous treatments were recorded. Drug survival was assessed using Kaplan–Meier survival curves and the log-rank test. Predictors of discontinuation were analyzed using univariate and multivariate Cox proportional hazards models. Results: A total of 103 patients (55.3% women) were included. Drug survival rates were 85% at one year, 73% at two years, and 61% at four years, with a mean treatment duration of 52.5 months (95% CI: 46.01–58.99). Multivariate analysis showed that patients under the age of 65 had a significantly higher risk of treatment discontinuation (hazard ratio: 1.813; p < 0.05). The most common reason for discontinuation was secondary treatment failure (45.16%). Ixekizumab demonstrated sustained drug survival in a real-world setting, with rates falling within the mid-to-upper range reported in the literature. Older age (>65 years) was associated with greater treatment persistence, highlighting a potential influence of age on long-term therapeutic adherence. Full article

The accurate determination of the equilibrium moisture content (EMC) of gel-related powdery samples requires strictly controlled conditions and a long time period. In this study, the adsorption and desorption isotherms of two fructooligosaccharide (FOS) powders and three inulin powders were determined using a dynamic moisture sorption analyzer at 0.1–0.9 water activity (a_w) and 20–35 °C, respectively. The adsorption and desorption isotherms all exhibited type IIa sigmoidal curves; the desorptive isotherm was smooth, the FOS adsorption curves had three inflection points, and the inulin adsorption curves had five inflection points. Large hysteresis between the adsorption and desorption isotherms occurred at 0.1–0.7 a_w for FOS and 0.1–0.6 a_w for inulin. Seven equations, Boquet, Ferro–Fontan, Guggenheim–Anderson–de Boer (GAB), Generalized D’Arcy and Watt (GDW), modified GAB (MGAB), Peleg, and our developed Polynomial, were found to fit the isotherms of the FOS and inulin samples; for adsorption, the best equations were Ferro–Fontan and GDW, and for desorption, the best equations were Polynomial and MGAB. The GDW and MGAB equations could not distinguish the effect of temperature on the isotherms, while the Polynomial equation could. The mean adsorptive monolayer moisture content (M₀) values in FOS and inulin samples were predicted as 7.29% and 7.94% wet basis, respectively. The heat of moisture sorption of FOS and inulin approached that of pure water at about 32.5% and 22.5% wet basis (w.b.) moisture content (MC), respectively. Fourier Transform Infrared Spectroscopy (FTIR) showed that the peaks in inulin with absorbance values above 0.52 and in FOS with absorbance values above 0.35 were at 1020, 1084, and 337 cm⁻¹; these could represent the amorphous structure (primary alcohol C-OH), C-O group, and hydroxyl functional group, respectively. Microscopic structure analysis showed that inulin powder particles were more round-shaped and adhered together, resulting in hygroscopic and sticky characteristics, with a maximum equilibrium moisture content (EMC) of 34% w.b. In contrast, the FOS powders exhibited irregular amorphous particles and a maximum EMC of 60% w.b. As hydrogels, 3–10% FOS or inulin addition reduced the peak, trough, final, breakdown, and setback viscosities of rice starch pasting, but increased the peak time and pasting temperature. FOS addition gave stronger reduction in the setback viscosity and in amylose retrogradation of rice starch pasting than inulin addition. The differential scanning calorimeter (DSC) showed 3–10% FOS addition reduced the amylopectin aging of retrograded paste of rice starch, but 5–7% inulin addition tended to reduce. These results suggest that FOS and inulin have strong hygroscopic properties and can be used to maintain the freshness of starch-based foods. These data can be used for drying, storage, and functional food design of FOS and inulin products. Full article

Background/Objectives: Cancer survivors can develop heart conditions such as aortic valve disease because of age and other shared risk factors. If this valve condition becomes symptomatic, the prognosis is poor if the valve is not replaced. Surgical aortic valve replacement (SAVR) is one mode of treatment. Methods: Of 2500 consecutive patients who underwent SAVR with a biological valve, 388 patients were cancer survivors. They were compared for preoperative characteristics, operative parameters, postoperative adverse events, need for resources, and long-term survival. For the latter, the six most common tumors (prostate, breast, colorectal, bladder, pulmonary, and hematologic) and the effect of the interval between cancer treatment and cardiac surgery were scrutinized. Results: Cancer increased significantly over time. Pulmonary and kidney disease differed between the groups, but cardiac comorbid conditions did not. Operative parameters, early adverse events, and need for resources did not differ. Median survival time was significantly reduced in cancer survivors: 104 (97–112) versus 119 (116–122) months, and this was driven by an interval of less than 5 years and prior lung cancer. Prior cancer was the least important of ten predictors for long-term mortality. Conclusions: The outcome of cancer survivors after SAVR is acceptable. For patients with pulmonary cancer, the outcome is poor. Full article

Sagittaria platyphylla (Engelm.) J.G.Sm. is an invasive aquatic plant of concern in Australian freshwater systems. Understanding its seed germination ecology and seedbank longevity is critical for effective management. This study examined environmental influences on germination and longevity through three controlled experiments. Seeds germinated between 17 and 29 °C, with optimal germination (96 ± 2%) at 21 °C under a 12/12 h light/dark photoperiod. High germination (93–99%) also occurred under light in diurnal regimes of 15/5 °C, 25/15 °C, and 30/20 °C. In a burial experiment, seedlings emerged only from surface-sown seeds (76 ± 4%); no emergence occurred from buried seeds, though viability remained high, peaking at 98 ± 2% at 2.5 cm depth. A controlled aging test indicated a 50% viability loss (P₅₀) in 36 days under warm, moist laboratory conditions. Based on established criteria, S. platyphylla produces short-lived seeds, which are likely to persist in the substrate seedbank for <1 to 3 years. The strong light dependence of germination suggests that sediment disturbance, which exposes buried seeds to light, could significantly enhance recruitment, highlighting the importance of minimizing disturbance for effective long-term management. Full article