Search Results (12,423)

The successful attainment of the Sustainable Development Goals (SDGs) necessitates robust monitoring frameworks capable of tracking progress toward tangible outcomes while capturing dynamic sustainability trajectories. However, existing SDG evaluation methods suffer from three critical limitations: (1) misalignment between global targets and national priorities, which undermines contextual relevance; (2) fragmented assessments that neglect holistic integration of social, economic, and ecological dimensions, thereby obscuring systemic interdependencies; and (3) insufficient longitudinal analysis, which restricts insights into temporal patterns of sustainable development and hinders adaptive policymaking. To address these gaps, we employed China’s 31 provinces as a case study and constructed an SDG indicator framework comprising 178 metrics—harmonizing global SDG benchmarks with China’s national development priorities. Using official statistics and open-source data spanning 2006–2021, we evaluate longitudinal SDG scores for all 17 goals (SDGs 1–17). Additionally, we developed a composite SDG index that considers the coupling coordination degree of the social–economic–ecological system and evaluated the index value under different economic region settings. Finally, we developed a two-threshold model to analyze the dynamic evolution of SDG conditions, incorporating temporal sustainability (long-term development resilience) and action urgency (short-term policy intervention needs) as dual evaluation dimensions. This model was applied to conduct a longitudinal analysis (2006–2021) across all 31 Chinese provinces, enabling a granular assessment of regional SDG trajectories while capturing both systemic trends and acute challenges over time. The results indicate that China’s social SDG performance improved substantially over the 2006–2021 period, achieving a cumulative increase of 126.53%, whereas progress in ecological SDGs was comparatively modest, with a cumulative growth of only 23.93%. Over the same period, the average composite SDG score across China’s 31 provinces increased markedly from 0.502 to 0.714, reflecting a strengthened systemic alignment between regional development trajectories and national sustainability objectives. Further analysis shows that all provinces attained a status of “temporal sustainability with low action urgency” throughout the study period, highlighting China’s overall progress in sustainable development. Nevertheless, pronounced regional disparities persist: eastern provinces developed earlier and have consistently maintained leading positions; central and northeastern regions exhibit broadly comparable development levels; and western regions, despite severe early-stage lagging, have demonstrated accelerated growth in later years. Our study holds substantial significance by integrating multi-dimensional indicators—spanning ecological, economic, and social dimensions—to deliver a holistic, longitudinal perspective on sustainable development. Full article

Background: Complete rectal prolapse (RP) is a debilitating pelvic floor disorder often accompanied by obstructed defecation syndrome (ODS), fecal incontinence, and LARS-like bowel dysfunction. Laparoscopic resection rectopexy (LRR) is an established abdominal approach; however, functional outcomes after LRR with transanal specimen extraction (LRR-TSE) are incompletely defined. Aim: To evaluate short- and long-term functional outcomes—ODS, Wexner incontinence score (WIS), and LARS—in patients undergoing LRR-TSE. Methods: This single-center cohort included 53 consecutive patients who underwent LRR-TSE between January 2013 and December 2019. Variables were prospectively recorded and analyzed retrospectively. ODS, WIS, and LARS scores were assessed preoperatively and at 3, 6, and 12 months. Longitudinal changes were analyzed using repeated-measures ANOVA with Greenhouse–Geisser correction, polynomial contrasts when appropriate, and Bonferroni-adjusted pairwise comparisons. Results: ODS improved significantly over time (p < 0.001), decreasing from 12.8 ± 3.2 preoperatively to 2.4 ± 2.1, 4.2 ± 2.2, and 5.2 ± 2.9 at 3, 6, and 12 months, respectively. LARS scores declined from 18.0 ± 12.7 at 3 months to 8.8 ± 6.8 at 6 months and 3.5 ± 4.2 at 12 months (p < 0.001). WIS showed a transient increase at 3 months (8.1 ± 5.2), followed by improvement at 6 and 12 months (3.2 ± 3.7 and 2.4 ± 3.0; p < 0.001). Sex and body mass index did not affect functional trajectories (p > 0.05), whereas patients aged ≥50 years had higher postoperative LARS and WIS scores (p < 0.05). Complications occurred in 5 patients (9.43%), including one anastomotic leak with a mortality rate of 1.85%. Full-thickness recurrence occurred in 2 patients (3.77%), and 3 developed mucosal prolapse managed with Delorme’s procedure. Conclusions: LRR-TSE is a safe and feasible minimally invasive technique that improves constipation, continence, and LARS-related bowel dysfunction. Early postoperative impairment may overestimate long-term functional severity, highlighting the need for follow-up beyond 12 months. Full article

Background: Patients with primary central nervous system (CNS) tumors often experience fatigue and sleep disturbances, significantly impacting their quality of life. Exercise has been shown to improve these symptoms in various cancer populations. The aim of this study is to evaluate the effects of different types of exercise on fatigue and sleep in less-investigated CNS tumor patients. Methods: A literature search was conducted in PubMed, Scopus, Cochrane Library, and CINAHL. Eligible randomized and non-randomized studies evaluating exercise interventions in patients diagnosed with primary brain tumors were systematically reviewed, primarily using a narrative synthesis approach. Cancer-related fatigue and sleep-related outcomes were extracted as variables of interest. Where possible [≥2 Randomized Control Trials (RCTs) available for glioma patients], meta-analyses were conducted to assess the overall effects of physical therapy on the above-mentioned outcomes. Results: A total of 15 relevant intervention studies were identified, either RCTs or other types of studies, such as prospective feasibility cohort studies and case studies. A total of 448 participants were enrolled, with the majority diagnosed with glioma. There were single reports on pituitary adenoma after surgery and meningioma patients. In glioma patients, the overall effect of various modality exercise interventions on fatigue was non-significant, reflecting the heterogeneous characteristics of studies with diverse outcomes. However, meta-analysis focusing on combined exercise interventions (aerobic and resistance training) showed a positive effect on reducing fatigue in these patients [Standardized Mean Difference (SMD) = 0.866, p = 0.03]. Fatigue in glioma patients may also improve through yoga and Pilates. Aerobic but not strength exercise seems to improve sleep in glioma patients (SMD = 1.14, p = 0.02). Sleep quality may also improve through yoga and combined exercise. Conclusions: Certain types of exercise appear to effectively reduce fatigue and improve sleep in patients with CNS tumors. Future, well–controlled, multi-arm, larger-scale studies are necessary to resolve discrepancies, as well as to explore long-term outcomes and define factors influencing individualized exercise responses. Full article

CRISPR/Cas systems have transformed molecular medicine, yet the field still lacks principled guidance on when transient editing suffices versus when sustained exposure through in vivo viral delivery is necessary and how to keep prolonged exposure safe. Notably, EDIT-101 was designed for a permanent edit in post-mitotic photoreceptors with lifelong Cas9 persistence. This review addresses this gap by defining the biological and therapeutic conditions that drive benefit from extended Cas activity while minimizing risk. We will (i) examine relationships between expression window and efficacy across Cas9/Cas12/Cas13 modalities, (ii) identify genome-wide off-target liabilities alongside orthogonal assays, and (iii) discuss controllable, self-limiting, and recallable editor platforms. By separating durable edits from persistent nuclease exposure, and by providing validated control levers, this work establishes a generalizable framework for safe, higher-efficacy CRISPR medicines. Furthermore, we highlight key studies in cell lines, murine models, non-human primates, and humans that examine the long-term effects of sustained expression of CRISPR/Cas systems and discuss the safety and efficacy of such approaches. Current evidence demonstrates promising therapeutic outcomes with manageable safety profiles, although there is a need for continued monitoring as CRISPR/Cas therapies are increasingly applied in clinical contexts and therapies are developed for broader clinical applications. Full article

Background: Three-dimensional virtual surgical planning (Three-dimensional VSP) has become standard practice in the treatment of mandibular oral squamous cell carcinoma (OSCC) in the last decade. Dutch guidelines recommend a care pathway interval (CPI) of a maximum of 30 days, and a free bone margin of at least 5 mm. Fused MRI and CT data are used for accurate tumor delineation. Based on this data, a virtual surgical plan is created and transferred to the operating room using resection guides and patient-specific implants (PSIs). Long-term evaluation is needed to further optimize its clinical use. Objectives: This study evaluates adherence to bone margin and CPI guidelines in mandibular OSCC. Additionally, it assesses the accuracy of tumor resection and reconstruction using 3D-VSP and compares the complications of 3D-planned mandibular reconstruction using different kinds of osteosynthesis plates. Methods: All patients who underwent a segmental mandibulectomy between 2014 and 2024 at the University Medical Center Groningen were included. CPI, clinical outcomes, and complications were analyzed. The preoperative virtual plan was compared with the postoperative outcome to assess accuracy. Results: The median CPI was 34 days, and 93.7% of bone margins were tumor-free. Mean absolute resection deviation was 1.63 mm (±1.42). PSI reconstructions were significantly more accurate in intergonial distance and coronal angle compared to conventional plates. Plate-related complications were more common in non-bony reconstructions; PSI reconstructions showed significantly more plate exposure. Conclusions: 3D-VSP leads to high accuracy in resection and reconstruction and favorable bone margins. Shortening the CPI and reducing biological complications are essential to further improve oncological outcomes. Full article

Meniscal preservation is increasingly recognized as a critical determinant of long-term knee joint health, yet successful repair remains challenging due to the meniscus’s limited intrinsic healing capacity. The adult meniscus is characterized by restricted vascularity, low cellularity, a dense extracellular matrix, complex biomechanical loading, and a hostile post-injury intra-articular inflammatory environment—factors that collectively impair meniscus healing, particularly in the avascular zones. Over the past several decades, a wide range of biologic augmentation strategies have been explored to overcome these barriers, including synovial abrasion, fibrin clot implantation, marrow stimulation, platelet-derived biologics, cell-based therapies, scaffold coverage, and emerging biologic and biophysical interventions. This review summarizes the biological basis of meniscal healing, critically evaluates current and emerging biologic augmentation techniques, and integrates these approaches within a unified framework of vascular, cellular, matrix, biomechanical, and immunologic targets. Understanding and modulating the cellular and molecular mechanisms governing meniscal degeneration and repair may enable the development of more effective, mechanism-driven strategies to improve healing outcomes and reduce the risk of post-traumatic osteoarthritis. Full article

Background/Objectives: Cutaneous tuberculosis (CTB) represents a rare extrapulmonary manifestation of Mycobacterium tuberculosis infection, accounting for approximately 1–2% of all tuberculosis cases. Despite its low incidence, CTB remains diagnostically challenging due to its clinical polymorphism and resemblance to other granulomatous or neoplastic dermatoses. Among its variants, lupus vulgaris (LV) constitutes the most common and indolent form in regions of moderate tuberculosis endemicity. The present study aims to highlight the diagnostic complexity, management, and long-term outcomes of LV, emphasizing its potential for malignant transformation into squamous cell carcinoma (SCC). Methods: We present a detailed case of lupus vulgaris in a male patient with a prolonged disease course, refractory to initial empiric therapy, successfully managed through anti-tubercular therapy (ATT) followed by surgical excision. A review of the literature was conducted to contextualize this case within the broader clinical spectrum of CTB, with particular attention to epidemiology, histopathology, and complications, including SCC development. Results: The patient demonstrated significant clinical improvement following standard six-month ATT; however, residual fibrotic lesions required excision for definitive management. Literature review revealed that chronic LV lesions persisting for decades may undergo malignant transformation. Analysis of reported cases underscores the importance of vigilance and early surgical intervention in long-standing or atypical LV. Conclusions: Lupus vulgaris remains a clinically deceptive entity requiring multidisciplinary management. Early recognition, appropriate ATT, and surgical excision of residual or recalcitrant lesions are crucial to prevent complications, including carcinogenesis. Greater clinician awareness of CTB’s diverse presentations may reduce diagnostic delays and improve outcomes. Full article

Background and Clinical Significance: Annular pancreas is a rare congenital anomaly in which pancreatic tissue partially or completely encircles the duodenum, potentially causing duodenal obstruction. Clinical presentation varies from asymptomatic cases to persistent vomiting, feeding intolerance, and failure to thrive, often leading to delayed diagnosis. Case Presentation: We report a 2-year and 10-month-old girl with a long-standing history of intermittent, recurrent vomiting since the neonatal period, without growth impairment or other alarming symptoms. Initial imaging suggested proximal duodenal dilation, with suspicion for superior mesenteric artery (SMA) syndrome. Endoscopy revealed mechanical obstruction at the second portion of the duodenum. Contrast-enhanced CT confirmed annular pancreas partially encircling the duodenum. The patient underwent duodeno-duodenostomy with an uneventful postoperative course and complete resolution of symptoms. This case illustrates the diagnostic challenges of annular pancreas in older children with atypical presentations. Multimodal imaging is crucial for accurate diagnosis. Surgical bypass remains the definitive treatment, offering excellent long-term outcomes. Conclusions: Persistent or recurrent vomiting in children, even without classic signs such as bilious vomiting or failure to thrive, should prompt consideration of annular pancreas. Early recognition and timely surgical intervention can prevent prolonged morbidity and ensure normal growth and development. Full article

Vaccination remains a cornerstone of infection prevention in adult solid organ transplant (SOT) recipients, a population at heightened risk for vaccine-preventable diseases due to chronic immunosuppression and comorbidities. Updated guidelines from the American Society of Transplantation Infectious Diseases Community of Practice (AST IDCOP) and other international bodies emphasize the need for timely and comprehensive vaccination strategies before and after transplantation. This review synthesizes current literature and practice guidelines on vaccination in adult solid organ transplant (SOT) candidates and recipients. Published peer-reviewed studies, clinical trials, and consensus guidelines were evaluated, with emphasis on vaccination timing, safety, immunogenicity, dosing strategies, and serologic response monitoring in the SOT population. Comprehensive vaccination planning before transplantation, combined with appropriate post-transplant booster strategies, remains vital to improving long-term outcomes in SOT recipients. This review provides clinicians with an updated, evidence-based framework for integrating evolving vaccination guidelines into the care of adult transplant patients. Full article

As global interest in sustainable nutrition grows, algae have emerged as a promising functional food resource. This review analyzes the nutritional value of edible algae, with a particular focus on protein-rich microalgae, and synthesizes current clinical evidence regarding their health benefits. Algae have been demonstrated to provide a broad spectrum of physiologically active nutrients, encompassing a range of vitamins and minerals as well as polyunsaturated fatty acids, antioxidant molecules and various bioactive compounds including dietary fiber. These nutrients have been linked to improved cardiovascular and metabolic health, enhanced immune function, and anti-inflammatory effects. A particular emphasis is placed on algal proteins as a novel alternative to traditional dietary proteins. Genera such as Spirulina and Chlorella offer high-quality, complete proteins with amino acid profiles and digestibility scores comparable to those of animal and soy proteins, thereby supporting muscle maintenance and overall nutritional status. Recent clinical studies have demonstrated that the ingestion of microalgae can stimulate muscle protein synthesis and improve lipid profiles, blood pressure, and inflammation markers, indicating functional benefits beyond basic nutrition. Algal proteins also contain bioactive peptides with antioxidative properties that may contribute to positive outcomes. This review synthesizes current studies, which demonstrate that algae represent a potent, sustainable protein source capable of enhancing dietary quality and promoting health. The integration of algae-based products into plant-forward diets has the potential to contribute to global nutritional security and long-term public health. However, the available clinical evidence remains heterogeneous and is largely based on small, short-term intervention studies, with substantial variability in algae species, processing methods and dosages. Consequently, while the evidence suggests the possibility of functional effects, the strength of the evidence and its generalizability across populations remains limited. Full article

As sustainability becomes a strategic priority, the Information Technology (IT) sector faces pressure on both reducing its environmental impact and leading in innovation. This study examines how Green Human Resource Management (GHRM) practices influence employees’ Green IT Attitudes (GITA) and beliefs within the IT industry. Guided by the Belief–Action–Outcome (BAO) framework, it explores how HR strategies can foster eco-conscious mindsets that support sustainable behaviour. A quantitative cross-sectional design was used, collecting data through a validated questionnaire. The study was conducted in Australia, focusing on IT professionals employed. Responses from 112 IT professionals, determined through G*Power sample estimation, were analysed using SPSS 28.0.1 with regression techniques to assess the relationship between GHRM practices and environmental attitudes and beliefs. Results indicate that GHRM practices have a modest but significant positive effect on employees’ green IT attitudes and beliefs, supporting the view that structured HR initiatives can shape sustainability-driven mindsets. The findings emphasize the strategic role of HR in embedding sustainability within organizational culture, particularly in technology-driven environments. The study offers practical guidance for IT organizations aiming to integrate sustainability into internal systems by leveraging HRM. Future research should examine moderating variables and long-term behavioural effects, enhancing our understanding of sustainability-focused HRM in the digital era. Full article

Exchange-traded funds (ETFs) provide low-cost, liquid access to broad equity and fixed-income exposures, including rapidly growing Asian and Asia-focused markets. Yet the academic evidence on Asian ETF portfolio construction remains fragmented, often limited to narrow country samples and centered on mean–variance trade-offs and standard performance statistics, with comparatively less emphasis on downside tail risk and on implementable long-only versus long–short designs under leverage constraints. This study examines the performance and risk characteristics of 29 Asian and Asia-focused ETFs over 2014–2025 and evaluates whether optimization using variance-based and tail-sensitive risk measures improves portfolio outcomes relative to a simple, implementable benchmark. We construct Markowitz mean–variance and conditional value-at-risk (CVaR) efficient frontiers and implement six optimized portfolios at the 95% and 99% tail levels under long-only and long–short configurations with leverage up to 30%. Performance is evaluated relative to an equally weighted Asian ETF benchmark using the Sharpe ratio and tail-sensitive measures, including the Rachev ratio and the stable tail adjusted return (STARR), complemented by fat-tail diagnostics based on the Hill tail-index estimator. The empirical results show that optimization improves efficiency relative to equal weighting in risk-adjusted terms and that moderate leverage can increase returns but typically amplifies volatility, dispersion, and drawdowns. Taken together, the evidence indicates that risk-measure choice materially affects portfolio composition and realized outcomes, with tail-based optimization generally producing more robust allocations than mean–variance approaches when downside risk is a primary concern. Full article

Background/Objectives: Individual responses to CFTR modulators vary widely among people with cystic fibrosis (pwCF), underscoring the need for functional approaches that provide biological context alongside genotype-based therapy selection. Nasal epithelial cultures provide an individual-specific model for theratyping, but most studies rely on freshly isolated cells, restricting repeated testing and long-term sample use. In this study, we tested whether CFTR modulator responses measured in biobanked nasal cells were associated with real-world clinical outcomes. Methods: Cryopreserved nasal epithelial cells from 23 pwCF were differentiated at the air–liquid interface and assessed for CFTR modulator-responsive ion transport using Ussing chambers. In vitro responses were correlated with 6-month changes in sweat chloride concentration (SCC), FEV₁, and BMI. Results: Cryopreserved cultures retained donor-specific CFTR modulator responsiveness. Modulator-induced forskolin/IBMX-stimulated currents correlated with changes in SCC (R = −0.512). CFTR inhibitor-sensitive currents correlated with FEV₁ (R = 0.564). Associations between forskolin/IBMX-stimulated currents and FEV₁ were positive but did not reach statistical significance using two-tailed analysis. BMI changes showed no significant association. Conclusions: Biobanked nasal epithelial cultures preserve clinically relevant CFTR modulator responses at the cohort level, supporting their use as functional assays for population-level assessment in cystic fibrosis. This cryopreservation-based strategy enables repeated testing and may expand access to theratyping beyond freshly obtained samples. Full article

Major hepatectomy (MH) has traditionally been associated with higher R0 rates in colorectal liver metastases (CRLM), but at the cost of increased morbidity. Parenchymal-sparing hepatectomy (PSH) has emerged as an alternative approach aimed at reducing perioperative complications while preserving functional liver parenchyma without compromising oncological outcomes. We retrospectively analyzed 248 consecutive patients undergoing liver resection for CRLM between 2016 and 2025, classified as PSH (n = 215, 86.7%) or MH (n = 33, 13.3%). MH was performed more frequently in patients with greater tumor burden, including larger lesions, more numerous metastases, and bilobar disease (all p < 0.001). PSH was associated with shorter hospital stay, fewer postoperative complications, and lower 30-day readmission rate. In multivariable Cox analyses, surgical strategy was not associated with recurrence-free survival or overall survival, which were primarily driven by tumor burden. Among patients who developed liver recurrence, repeat hepatectomy was more often feasible after PSH than MH (p = 0.026), emphasizing the long-term value of preserving functional parenchyma. Overall, PSH was associated with lower postoperative morbidity, enabling earlier recovery, while facilitating future liver resections when needed in this chronically evolving disease. Full article

This systematic review examines chronic kidney disease-associated pruritus (CKD-aP) as a complex clinical manifestation in patients undergoing hemodialysis. Traditionally considered a secondary symptom of end-stage renal disease, emerging evidence now positions CKD-aP as a multidimensional disorder with substantial pathogenic influence on patient outcomes. Using the PRISMA 2020 methodology, we critically evaluated 54 peer-reviewed studies published between 2020 and 2025. Our synthesis highlights a convergence of five mechanistic frameworks underpinning CKD-aP: elevated levels of uremic toxins originating from gut microbial dysbiosis, immune activation driven by IL-31 and other pro-inflammatory cytokines, heightened peripheral and central neural sensitization, dysregulation of endogenous opioid receptor pathways favoring μ-receptor activation, and xerosis-related epidermal barrier dysfunction. These mechanisms contribute to a systemic cycle of microinflammation, pruritogenic signaling, and neural hyperexcitability. We also identified and compared validated assessment tools—including the NRS, VAS, Skindex-10, and the UP-Dial scale—that facilitate standardized quantification of disease burden. While available treatments such as gabapentinoids and phototherapy offer partial relief, targeted therapies—including κ-opioid receptor agonists—represent a major advancement, although long-term effectiveness and accessibility remain under investigation. Growing scientific consensus establishes CKD-aP as a priority therapeutic target in hemodialysis care, underscoring the need for integrated, mechanism-based management strategies to improve quality of life and clinical outcomes. This work represents a narrative systematic review, integrating evidence from mechanistic, translational, and clinical studies to critically examine the biological pathways underlying CKD-associated pruritus. Full article