Search Results (7,480)

Background/Objectives: Obstructive sleep apnea (OSA) is a highly prevalent sleep-related breathing disorder caused by recurrent upper-airway collapse during sleep, leading to intermittent hypoxia, sleep fragmentation, and excessive daytime sleepiness. Although continuous positive airway pressure (CPAP) remains the first-line therapy, long-term adherence is often suboptimal, underscoring the need for more tolerable and flexible treatment options. This review aims to summarize the pathophysiological rationale for pharmacotherapy in OSA and to discuss recent developments in drug-based interventions. Methods: We conducted a narrative review of the literature on pharmacological interventions for OSA, with a systematic search of PubMed, Embase, Cochrane Library, and ClinicalTrials.gov up to 4 August 2026. We included randomised controlled trials, observational studies, meta-analyses, and mechanistic human or animal studies that reported relevant sleep and respiratory outcomes, and graded evidence according to the principles of GRADE framework. Results: Several drug classes have shown promise: agents that increase upper-airway dilator muscle activity, respiratory stabilizers that reduce loop gain, medications that raise the arousal threshold, topical anti-inflammatory drugs for mucosal edema, and systemic metabolic modulators such as glucagon-like peptide-1 receptor agonists and dual incretin receptor agonists. Emerging strategies, including gene therapy directed at the hypoglossal motor system, are also under investigation at the preclinical stage. Moreover, combining pharmacotherapy with CPAP or other devices can produce synergistic benefits, enabling lower device pressures and enhanced patient comfort. Conclusions: Pharmacotherapy for OSA is progressively moving from exploratory research towards targeted, phenotype-driven personalized treatment. Future studies should focus on robust patient phenotyping, multi-mechanistic combination regimens, and long-term clinical outcome evaluations to facilitate the integration of drug-based therapies into routine OSA management, particularly in specific subgroups such as those with COMISA. Full article

This study focused on dietary supplementation with flaxseed in fattening pigs to observe health benefits and important biological findings, including cell membrane integrity, proliferation, and angiogenesis. Animals received flaxseed for 6 or 3 weeks prior to slaughter. Pigs were divided into a control group (standard diet) and experimental groups F6 (6 weeks) and F3 (3 weeks), which received flaxseed in the feed. Spectroscopy followed by an electrophoretic method was used to study the levels of basic biochemical parameters, including LDH. Subsequently, gas chromatography revealed fatty acid concentrations in the pigs’ livers, and finally, immunohistochemical analysis was used to detect CD31 and PCNA antigens in the liver and jejunum. The highest weight gain was measured in the F6 group. After slaughter, blood samples revealed a decreased glucose level in the F6 group, maintained levels of basic biochemical parameters, and decreased concentrations of LDH in blood, heart, liver, and skeletal muscle extracts, thus improving cell membrane integrity. A long-term supplementation period led to better utilization of essential fatty acids, an improved n-6:n-3 ratio, and other atherogenic indices related to cardiovascular health. Flaxseed also affected the expression of CD31 and PCNA proteins in the liver and jejunum, mainly in the F6 group. Full article

Physical activity is widely recognized as a fundamental component of health promotion and chronic disease prevention. Historically the focus has primarily been on aerobic exercise, while resistance training has received comparatively less attention. This imbalance underestimates the critical role of muscular performance in supporting physical health, functional capacity, long-term mobility, and overall quality of life. Current physical activity guidelines for Americans recommend that adults engage regularly in both aerobic and muscle-strengthening activities. However, only approximately one-quarter of adults in the United States meet these recommendations, despite nearly half achieving recommended levels of aerobic activity alone. Although any form of physical activity can confer health benefits, participation in both aerobic exercise and muscle-strengthening, such as resistance training, produces more comprehensive and substantial health outcomes. As research on resistance training has evolved beyond its traditional focus on athletic performance, a growing body of evidence has demonstrated its effectiveness in the prevention and management of numerous chronic conditions. This narrative review summarizes the role of resistance training in the prevention and management of several prevalent lifestyle-related chronic conditions, including type 2 diabetes, obesity, hypertension, cardiovascular disease, dyslipidemia, and osteoporosis. Full article

Oral, live-attenuated rotavirus vaccines (ORVs) have significantly reduced severe diarrheal disease and deaths; however, vaccine performance in low- and middle-income countries (LMICs) remains lower than in high-income countries. With increasing global use, real-world data now provide important insights into strategies to improve vaccine impact in these settings. This review summarizes current evidence on the effectiveness and impact of ORVs in LMICs, with a focus on approaches to optimize performance, including alternative dosing schedules, booster doses in late infancy, and mixed vaccine regimens. Evidence on vaccine interchangeability offers practical solutions for countries facing supply disruptions and financial constraints. The review also highlights the growing importance of economic sustainability, particularly in the context of transitions from external funding support. Despite lower efficacy, ORVs continue to provide substantial public health benefits in LMICs. Sustained impact will depend on strengthening programme delivery, ensuring stable vaccine supply, and advancing next-generation vaccines. Continued evaluation of effectiveness, cost, and implementation strategies will be critical to maximizing long-term benefits in high-burden settings. Full article

Despite rising foreign direct investment (FDI), Sub-Saharan Africa continues to experience inadequate energy infrastructure and weak sustainable development outcomes, suggesting that investment alone is insufficient to generate long-term development gains. This study investigates whether energy infrastructure conditions the relationship between FDI and sustainable development in 35 Sub-Saharan African countries over the period 2000–2024. Sustainable development is measured using adjusted net savings, while energy infrastructure is proxied by the Energy Infrastructure Composite Index. The analysis employs complementary second-generation panel estimators, including fixed effects with Driscoll–Kraay standard errors, common correlated effects mean group, Augmented Mean Group, System Generalized Method of Moments, and panel quantile regression to address cross-sectional dependence, slope heterogeneity, endogeneity, dynamic persistence, and distributional heterogeneity. The results demonstrate that FDI exerts adverse effects on sustainable development where energy infrastructure is weak but generates significant positive outcomes as infrastructure improves. Institutional quality consistently emerges as the most robust determinant across all estimators and quantiles, while the positive interaction between FDI and energy infrastructure confirms that stronger energy systems enhance countries’ absorptive capacity. The findings underscore the need for coordinated investments in energy infrastructure and institutional reforms to maximize the sustainable development benefits of foreign investment in Sub-Saharan Africa. Full article

Hepatocellular carcinoma (HCC) is the most common primary liver cancer and is frequently diagnosed at advanced stages, thereby limiting curative treatment options. Although interventions with curative intent, such as liver resection and ablation, are available, recurrence rates exceed 70%. Recent developments in HCC management have shifted the focus from conventional surgery and targeted therapies to immunotherapy. This review synthesizes current evidence on immunotherapy for curative purposes in HCC, including both neoadjuvant and adjuvant strategies. It evaluates completed and ongoing clinical trials of immune checkpoint inhibitors (ICIs), administered as monotherapy or in combination with anti-angiogenic agents or dual-checkpoint blockade. ICIs may transform the initial treatment paradigm for advanced HCC, although their applications remain in the investigational stage. Preliminary results from the IMbrave050 trial suggested that adjuvant immunotherapy following radical liver resection improves recurrence-free survival (RFS) in high-risk patients. However, the initially promising outcomes of the combination of atezolizumab and bevacizumab compared with active surveillance were not sustained in the median follow-up, and long-term survival results are awaited. Although several studies have demonstrated encouraging preliminary results, a clear survival benefit has not yet been established. Further studies are necessary to establish definitive conclusions. Immunotherapy has a pathophysiological basis and preliminary evidence to redefine HCC management across disease stages; its integration into pre- and post-operative strategies may increase resectability, reduce recurrence, and improve survival. Ongoing trials are expected to clarify its exact role. Full article

Existing industrial buildings represent a critical but under-addressed field for operational carbon emission reduction, as retrofit decisions are constrained by production continuity, limited investment capacity, and heterogeneous technical options. This study developed a decision support framework integrating the Decision-Making Trial and Evaluation Laboratory (DEMATEL) and Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) methods to evaluate and prioritize operational phase decarbonization retrofit schemes for existing industrial buildings. The framework was applied to the Thyssenkrupp S Plant in eastern China, where ten candidate schemes were identified through an energy audit, on-site investigation, and expert consultation. The results show that heating, ventilation, and air conditioning (HVAC) operational control and temperature set-point optimization ranked first, followed by lighting operational management and automatic control. These management-based measures offer strong near-term applicability because of their low investment, short payback periods, limited implementation disturbance, and immediate emission reduction benefits. Their sustained effectiveness, however, requires standardized procedures, staff education, energy monitoring, and appropriate automation. Rooftop photovoltaics provide the largest annual carbon reduction but have a lower short-term priority because of their high upfront investment. Expert-consistency testing and sensitivity analyses, including criterion weight perturbation, preference scenarios, and Monte Carlo simulation, support the robustness of the leading ranking pattern. The findings support staged retrofit planning that prioritizes durable management measures in the short term, equipment-level efficiency improvements in the medium term, and renewable energy deployment in the long term. Full article

Background: Fetal programming, conceptualized within the Developmental Origins of Health and Disease framework, describes how intrauterine exposures may shape long-term offspring physiology and disease susceptibility. Metformin is increasingly used during pregnancy for gestational diabetes mellitus, type 2 diabetes mellitus, and selected cases of polycystic ovary syndrome. Its developmental interpretation is complex because the drug improves the maternal metabolic environment but also crosses the placenta and directly exposes the fetus. Methods: This focused narrative review used iterative, targeted searches of PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar to identify pharmacological, placental, mechanistic, clinical, guideline-based, and offspring follow-up evidence. The literature search covered publications available through 31 May 2026. The manuscript was subsequently revised during the editorial submission and peer-review process, and the evidence synthesis was re-evaluated against this final literature cut-off date. Earlier landmark studies were retained where necessary for historical, pharmacological, or methodological context. Results: Metformin reduces hepatic glucose production and maternal insulin resistance and may limit gestational weight gain, insulin requirements, neonatal hypoglycemia, and excessive fetal growth in selected pregnancies. Placental transfer creates biological plausibility for direct effects on AMPK, mitochondrial, mTOR, nutrient-sensing, and epigenetic pathways. Long-term studies are broadly reassuring regarding neurodevelopment and major metabolic disease, but findings on growth trajectory, adiposity, and small-for-gestational-age risk remain heterogeneous and indication-dependent. Conclusions: Metformin should be interpreted neither as uniformly beneficial nor as developmentally neutral. Its use should be individualized according to maternal phenotype, indication, glycemic benefit, placental function, fetal growth, dose, timing, and the limitations of long-term offspring evidence. Full article

Kombucha is a fermented tea beverage produced by a symbiotic culture of bacteria and yeast (SCOBY) containing a complex matrix of organic acids, polyphenols, electrolytes, and live microorganisms. Tea is the world’s most widely consumed beverage after water, and fermentation transforms its sensory properties in ways that have contributed to kombucha’s growing global popularity alongside its perceived health benefits; yet, despite widespread consumption and long-standing traditional use, controlled human data are relatively recent and sparse. This review integrates clinical, mechanistic, sensory, cultural, and public health perspectives to evaluate kombucha as a functional fermented beverage. A randomised, placebo-controlled crossover trial demonstrated that consumption of live kombucha with a high-glycaemic-index meal significantly reduced postprandial glycaemia and insulinaemia, lowering the glycaemic index from 86 to 68 (approximately 20% reduction). A pilot randomised controlled study in adults with type 2 diabetes reported reductions in fasting blood glucose following four weeks of regular kombucha consumption. Most recently, a 10-week RCT in adults with excess body weight demonstrated significant within-group reductions in total cholesterol, LDL-c, VLDL-c, triglycerides, Castelli II index, and uric acid, as well as reduced hydrogen peroxide levels and improved gastrointestinal symptoms, following daily green tea kombucha consumption combined with an energy-restricted diet. Mechanistically, these effects likely arise from synergistic interactions between organic acids, polyphenols, vitamins, minerals, and microbial communities influencing gastric emptying, carbohydrate and lipid digestion, gut microbiota composition, antioxidant defence, and hydration physiology. While promising, current evidence requires confirmation in larger, longer-term trials before definitive clinical recommendations can be made. Full article

Nanomaterials are increasingly used in manufacturing, medicine, consumer products, and environmental technologies due to their unique physicochemical properties. Although these materials offer substantial technological and societal benefits, their widespread use has raised concerns about potential health risks. Of particular importance is exposure during pregnancy, as certain nanoparticles can cross the placental barrier and reach the developing embryo. Fetal tissues are highly sensitive to environmental insults, so maternal exposure to nanoparticles may disrupt normal development and increase the risk of abnormal pregnancy outcomes. This review examines the current understanding of nanoparticle-induced developmental toxicity, with a focus on the vulnerability of the maternal–fetal unit. We discuss the structure and function of the placental barrier and the mechanisms that enable nanoparticle transfer from mother to fetus. Particular attention is given to how nanoparticle characteristics, including size, shape, composition, and surface chemistry, influence biodistribution, placental transport, tissue accumulation, and toxicity. We summarize the major molecular and cellular mechanisms implicated in fetotoxicity, highlighting oxidative stress, apoptosis, autophagy, and DNA damage as recurring pathways identified across experimental studies. These interconnected processes contribute to placental dysfunction, impaired fetal growth, developmental abnormalities, and adverse pregnancy outcomes. We also compare findings across different classes of nanoparticles, including metal, metal oxide, carbon-based, and polymeric nanomaterials, identifying both shared toxicological mechanisms and material-specific effects. Evidence from animal models demonstrates that susceptibility varies according to nanoparticle properties, exposure conditions, and species, underscoring the complexity of nanoparticle–biological interactions and the limitations of extrapolating experimental findings directly to humans. Overall, the available evidence indicates that nanoparticle exposure during pregnancy represents a potential risk to fetal health, although important knowledge gaps remain regarding human exposure and long-term developmental outcomes. A better understanding of the mechanisms underlying nanoparticle-induced fetotoxicity is essential for improving human health risk assessment, refining experimental models, informing regulatory policies, and supporting the safe-by-design development of nanomaterials. Such knowledge will help ensure the responsible application of nanotechnology while minimizing potential risks during pregnancy. Finally, this review is distinguished by its integrated analysis of how the chemical characteristics of nanoparticles govern placental transfer and the mechanistic pathways of fetotoxicity across multiple nanomaterial classes, providing a unified framework that connects material properties with their potential for abnormal fetal development and adverse pregnancy outcomes. Full article

Neonatal hypoxic–ischemic encephalopathy (HIE) remains one of the leading causes of neonatal mortality and long-term neurodevelopmental disability despite therapeutic hypothermia, which provides only partial neuroprotection. Among adjunctive therapies, magnesium sulfate (MgSO₄) has emerged as one of the most biologically plausible neuroprotective agents because of its ability to modulate glutamate-mediated excitotoxicity, intracellular calcium influx, oxidative stress, neuroinflammation, and apoptotic pathways. Nevertheless, encouraging molecular and preclinical findings have not translated into consistent clinical benefit. This narrative review critically examines the translational gap between the molecular mechanisms of magnesium sulfate and its clinical performance in neonatal HIE. Evidence from experimental models, clinical studies and recent meta-analyses was integrated to identify the biological and methodological factors potentially responsible for this discrepancy. We discuss the evolving pathophysiology of HIE across the primary, latent, secondary and tertiary phases of brain injury and analyze how the timing of intervention, lesion heterogeneity and inadequate biological stratification may influence therapeutic responsiveness. Current clinical research has largely evaluated broad neurological outcomes, particularly cerebral palsy, despite the heterogeneous neuropathological substrates underlying neonatal brain injury. We argue that this strategy may dilute genuine treatment effects by grouping together distinct lesion phenotypes with different biological mechanisms. Accordingly, we propose the “Neuroprotection per Effective Therapy (NET)” framework, a conceptual translational model integrating molecular targets, experimental evidence, MRI-defined lesion phenotypes, methodological quality, and advanced statistical approaches to improve patient stratification and outcome selection. Rather than questioning the biological efficacy of magnesium sulfate itself, this review suggests that future progress will depend on aligning molecular mechanisms with clinically meaningful phenotypes. Precision-based translational strategies may ultimately allow magnesium sulfate and other neuroprotective therapies to better reveal their therapeutic effects in biologically appropriate patient subgroups. Full article

Cover cropping can be a promising management strategy to improve soil health in the tropics. Our study evaluated physical, chemical, and microbiological indicators of soil health three years after implementing a maize and cowpea cover crop rotation with five fertilizer rates in replicated plots on a Torrifluventic Haplustepts in the southern semiarid coast of Puerto Rico. The Soil Management Assessment Framework (SMAF) was used to integrate different soil parameters to provide a comprehensive overview of soil health changes. Water aggregate stability (WAS) was not affected by cover crops. Soil pH significantly decreased with increasing nitrogen (N) fertilization rate and with cover crop rotation. Chemical and microbial indicators of soil health related to organic matter dynamics and nutrient cycling potential [e.g., microbial biomass nitrogen (MBN), potentially mineralizable N (PMN), β-glucosidase activity, combined enzyme activity for carbon (C), N, and phosphorus (P) cycling (β-glucosidase, β-glucosaminidase, and acid phosphatase] were significantly (p < 0.1) improved by cover crop but were not affected by fertilizer rate or cover crop x fertilizer rate. Fatty acid methyl esters (FAME) analysis showed that only G+ bacteria were significantly higher due to cover cropping. Principal component analysis revealed that total FAMEs and markers for G+ bacteria, G− bacteria, actinobacteria, and saprophytic fungi responded similarly to management and were generally influenced by cover cropping. Overall, improvements in microbial communities led to significant increases in key functions supporting soil health and sustainability within just three years of cover cropping adoption. The SMAF, as a well-known soil quality/health index, detected early benefits of using cover crops. Our study provided evidence that these indicators can serve as tools to assist farmers in selecting sustainable management practices such as cover crops in the tropics, yet long-term monitoring is still needed. Full article

Background: The global prevalence of oral disease including dental caries varies significantly across different regions, and South Africa is no exception. Although dental caries is a major public health concern, it is largely preventable through the promotion of proper oral hygiene practices and screening. The study aimed to assess the oral health status of school children within selected primary schools in the Tshwane District, South Africa. Methods: The study used a quasi-experimental design employing a quantitative research approach, structured into three phases: a pre-test assessment, the implementation of the intervention, and a post-test evaluation. A total of 390 primary school learners from five selected schools underwent dental screening and were included in the study on a voluntary basis. Data analysis was conducted using IBM SPSS version 30, incorporating both descriptive and inferential statistical tools. Results: Prior to screening, 75.9% of participants exhibited dental caries, while only 24.1% showed no signs of tooth decay. Following the intervention, improvements in oral hygiene status were observed among participants. The proportion of children presenting with high plaque scores decreased markedly from 19.0% at baseline to 1.8% post-intervention. Similarly, the prevalence of poor oral hygiene declined from 30.1% pre-intervention to 16.2% after the intervention, indicating an overall enhancement in hygiene practices. The proportion of dmft in primary teeth recorded 37.3% pre intervention, higher than post intervention (23.2%). Additionally, the record of DMFT in permanent teeth (49.2%) pre-intervention compared to the post intervention (40.8%). The study reported a similar percentage on the treatment during pre and post intervention (75.9%). Conclusions: Dental screening intervention yielded promising short-term results, particularly in plaque reduction and caries detection. However, its long-term success hinges on integrating school efforts with parental support and improving access to follow-up dental care. A comprehensive, multi-stakeholder approach remains essential to ensure lasting oral health benefits for children. Full article

Neurodegenerative conditions are incurable, progressive disorders characterized by the slow and irreversible loss of neurons. This neuronal loss can lead to several neuropsychiatric disorders and long-term complications. Despite significant advances in understanding the mechanisms of neurodegenerative disease, currently, there is no cure for neurodegenerative diseases, highlighting the urgent need for novel neuroprotective strategies. Alkaloids are an important class of bioactive substances that exhibit neuroprotection against several neurodegenerative diseases. Tryptanthrin, an indoloquinazoline alkaloid, shows strong anti-inflammatory, antioxidant, and neuroprotective properties. In this review, we described the pathophysiology of neurodegenerative diseases and summarized several alkaloids’ neuroprotective properties. Furthermore, we showed protective benefits of tryptanthrin and its derivatives against neurodegenerative illnesses, focusing on their modulation of oxidative stress, neuroinflammation, neuronal death, and related signaling pathways in cellular and animal models of neurodegenerative diseases. However, various challenges, such as clinical evidence, pharmacokinetic studies, and long-term treatment effects, are not well documented. Future research on tryptanthrin and its derivatives should focus on the optimization of drug delivery methodologies and clinical studies to establish its potential as a therapeutic candidate for neurodegenerative diseases. Full article

Stroke remains one of the leading causes of death and long-term neurological disability worldwide, while currently available therapeutic strategies are limited by narrow treatment windows and incomplete neuroprotection. In this context, plant-derived polyphenols have attracted increasing attention as potential adjunctive agents because of their multimodal biological activity. This review focuses on resveratrol and curcumin, two of the most extensively investigated polyphenols, and evaluates their potential role in the prevention and treatment of ischaemic and haemorrhagic stroke. Evidence from in vitro studies, animal models, and early clinical trials indicates that both compounds may attenuate key mechanisms involved in stroke-related brain injury, including oxidative stress, neuroinflammation, mitochondrial dysfunction, apoptosis, autophagy dysregulation, blood–brain barrier disruption, and microglial activation. Emerging evidence further suggests that interactions with the gut microbiota and modulation of the gut–brain axis may contribute to their biological effects by influencing intestinal barrier integrity, microbial metabolite production, systemic inflammation, and vascular risk. Preclinical studies show that resveratrol and curcumin can reduce infarct volume, limit cerebral oedema, preserve neuronal viability, promote angiogenesis and neurogenesis, and improve neurological and cognitive outcomes. Their beneficial effects have been reported both when administered before stroke onset and after cerebral injury, suggesting potential relevance for both prevention and post-stroke therapy. However, interpretation of these findings requires consideration of the translational limitations of experimental stroke models, which do not fully reproduce the heterogeneity, comorbidities, age profile, and variable reperfusion patterns characteristic of human stroke. Although commonly used models such as middle cerebral artery occlusion provide important mechanistic and therapeutic insights, preclinical efficacy should therefore not be regarded as a direct predictor of clinical benefit. Resveratrol and curcumin may also complement established and emerging treatment strategies, including thrombolysis, endovascular interventions, antihypertensive therapy, and stem cell-based approaches. Nevertheless, their clinical translation remains limited by poor solubility, low bioavailability, rapid metabolism, and insufficient clinical evidence. Novel formulations, including nanoparticles, exosome-based delivery systems, and structurally modified analogues, may help overcome these barriers by improving brain targeting and therapeutic efficacy. Overall, resveratrol and curcumin represent promising but still investigational candidates for adjunctive stroke therapy, requiring further well-designed clinical trials to define their optimal dosing, timing, safety, and clinical value. Full article