Search Results (1,006)

Background: Arteriovenous fistulas (AVFs) may contribute to cardiac remodeling and consequently to an increased risk of heart failure and cardiovascular mortality in patients with end-stage kidney disease (ESKD). We aimed to assess cardiac changes following AVF creation and identify potential parameters associated with cardiac remodeling. Methods: In our prospective, single-center study, ESKD patients without significant pre-existing cardiac disease underwent 2D and 3D echocardiographic evaluation before and after AVF creation, along with AVF flow measurement. Cardiac remodeling was assessed using 3D indexed left and right ventricular end-diastolic volumes (LVEDVi, RVEDVi), while systolic function was assessed using longitudinal strain and 3D ejection fraction. Results: We included 20 patients (18 men; median age 73.5 years [IQR: 67–77]) with a mean AVF flow of 1140 ± 345 mL/min. At a median of 8.2 months (IQR: 7.3–9.3) following AVF creation, significant biventricular dilatation was observed: LVEDVi increased from 89 ± 14 to 97 ± 21 mL/m² (p < 0.05) and RVEDVi from 80 ± 15 to 91 ± 18 mL/m² (p < 0.05), while the systolic function of both ventricles did not change significantly. The right ventricle showed the most pronounced remodeling and it was independently associated with volume overload (p = 0.003) and elevated left ventricular filling pressure (p = 0.030), but not with AVF flow. Conclusions: Moderate AVF flow was associated with cardiac remodeling, primarily affecting the right ventricle. Fluid overload and left ventricular filling pressure were key factors associated with right ventricular remodeling, underscoring the need for careful fluid management and vascular access planning in ESKD patients. Full article

The rapid growth of electric vehicles (EVs) and new energy systems has put lithium-ion batteries at the center of the clean energy change. Nevertheless, to achieve the best battery performance, safety, and sustainability in many changing circumstances, major innovations are needed in Battery Management Systems (BMS). This review paper explores how artificial intelligence (AI) and digital twin (DT) technologies can be integrated to enable the intelligent BMS of the future. It investigates how powerful data approaches such as deep learning, ensembles, and models that rely on physics improve the accuracy of predicting state of charge (SOC), state of health (SOH), and remaining useful life (RUL). Additionally, the paper reviews progress in AI features for cooling, fast charging, fault detection, and intelligible AI models. Working together, cloud and edge computing technology with DTs means better diagnostics, predictive support, and improved management for any use of EVs, stored energy, and recycling. The review underlines recent successes in AI-driven material research, renewable battery production, and plans for used systems, along with new problems in cybersecurity, combining data and mass rollout. We spotlight important research themes, existing problems, and future drawbacks following careful analysis of different up-to-date approaches and systems. Uniting physical modeling with AI-based analytics on cloud-edge-DT platforms supports the development of tough, intelligent, and ecologically responsible batteries that line up with future mobility and wider use of renewable energy. Full article

Healthy soils are an essential ingredient of land systems and ongoing global change. Urbanization as a global change process often works through the lens of urban planning, which involves urban agriculture, urban greening, and leveraging nature-based solutions to promote resilient cities. Yet, urbanization frequently leads to soil erosion. Despite recognition of this tension, the rate at which the urban growth boundary accelerates soil erosion above natural background levels has not yet been determined. Our goal here is to provide a first broad estimate of urbanization’s impact of soil erosion. By combining data on modern erosion levels with techniques for estimating long-term natural erosion rates through cosmogenic nuclide ¹⁰Be analysis, we modeled the impact of urbanization on erosion across a range of cities in different global climates, revealing an acceleration of soil erosion ~7–19x in environments with mean annual precipitation <1500 mm; growth in wetter urban centers accelerated soil erosion ~23–72x. We tested our statistical model by comparing natural erosion rates to decades of monitoring soil erosion on the margins of Phoenix, USA. A century-long expansion of Phoenix accelerated soil erosion by ~12x, an estimate that is roughly at the mid-point of model projections for drier global cities. In addition to urban planning implications of being able to establish a baseline target of natural rates of soil erosion, our findings support the urban cycle of soil erosion theory for the two USA National Science Foundation urban long-term ecological research areas of Baltimore and Phoenix. Full article

Background: High-sensitivity cardiac troponin (hs-cTn) is useful for detecting acute myocardial infarction, but chronic hemodialysis patients often have elevated baseline levels that exceed the upper reference limit (URL). This study aimed to determine whether hs-cTnI levels in asymptomatic hemodialysis patients exceed the URL established for the general population, evaluate the impact of high-flux hemodialysis on hs-cTnI concentrations, and examine associations between hs-cTnI levels and subsequent hospitalization or mortality. Methods: A prospective, single-center cohort study was conducted at a tertiary care center from August 2023 to July 2024. Blood samples for hs-cTnI were collected from asymptomatic hemodialysis patients aged ≥ 40 years, measured before and after dialysis within one month. Patients were followed for up to 12 months. Results: Fifty-six patients were enrolled. The mean hs-cTnI levels were 28.4 ng/L pre-dialysis and 27.9 ng/L post-dialysis, with ranges of <6–223 ng/L and <6–187 ng/L, respectively. The mean hs-cTnI delta between pre- and post-dialysis was −0.5 ng/L, with 52% showing a negative delta, 30% no change, and 18% a positive delta. No association was found between baseline hs-cTnI levels and mortality or hospitalization during follow-up. Conclusions: Most asymptomatic hemodialysis patients had hs-cTnI levels in the “gray zone”, thus neither confirming nor excluding acute myocardial infarction. Dialysis did not significantly affect hs-cTnI levels, and elevated baseline hs-cTnI was not linked to increased mortality or hospitalization over 12 months. Full article

Corydalis yanhusuo W. T. Wang, commonly known as Yanhusuo, is an important and rare medicinal plant resource in China. Its habitat integrity is facing severe challenges due to climate change and human activities. Establishing an integrative quality zoning system for this species is of significant practical importance for resource conservation and adaptive management. This study integrates multiple data sources, including 121 valid distribution points, 37 environmental factors, future climate scenarios (SSP126 and SSP585 pathways for the 2050s and 2090s), and measured content of tetrahydropalmatine (THP) from 22 sampling sites. A predictive framework for habitat suitability and spatial distribution of effective components was constructed using a multi-model coupling approach (MaxEnt, ArcGIS spatial analysis, and co-kriging method). The results indicate that the MaxEnt model exhibits high prediction accuracy (AUC > 0.9), with the dominant environmental factors being the precipitation of the wettest quarter (404.8~654.5 mm) and the annual average temperature (11.8~17.4 °C). Under current climatic conditions, areas of high suitability are concentrated in parts of Central and Eastern China, including the Sichuan Basin, the middle–lower Yangtze plains, and coastal areas of Shandong and Liaoning. In future climate scenarios, the center of suitable areas is predicted to shift northwestward. The content of THP is significantly correlated with the mean diurnal temperature range, temperature seasonality, and the mean temperature of the wettest quarter (p < 0.01). A comprehensive assessment identifies the Yangtze River Delta region, Central China, and parts of the Loess Plateau as the optimal integrative quality zones. This research provides a scientific basis and decision-making support for the sustainable utilization of C. yanhusuo and other rare medicinal plants in China. Full article

(1) Background: Comparison of clinical outcomes between patients with moderate-severe aortic valve stenosis and those with mild or no aortic valve stenosis undergoing surgical revascularization for critical limb threating ischemia (CLTI). (2) Methods: Single center retrospective analysis of consecutive patients undergoing surgical lower limb revascularization with femoro-distal bypass for critical ischemia between 2016 and 2022. All patients were evaluated preoperatively by echocardiographic examination and divided into two cohorts: group A with moderate-severe aortic valve stenosis (AVA-cm² < or =1.5 cm²) and group B with mild or absent stenosis (AVA-cm² > 1.5 cm²). Primary outcomes were major limb amputation and mortality between the two groups. The rate of major cardiovascular events (stroke, myocardial infarction, sudden cardiac death) and change in “preoperative functional status” were the secondary outcomes. Descriptive statistics for continuous variables were performed by calculating means, standard deviation (SD) medians, and interquartile range (IQR) while, for categorical variables, frequencies and percentages were performed. Intergroup comparison tests, for continuous variables, were performed by t-test or corresponding nonparametric tests (Mann-Whitney test) while, for categorical variables, Chi-square test was used. Evaluation of cut-offs for the variable AVA-fx-cm², in terms of predictive of outcome outcomes, was calculated by ROC curves. Comparison between clinical and outcome variables was performed using logistic regression models. A total of 316 patients were analyzed and divided in two groups: 50 (16%) patients with moderate or severe aortic valve stenosis (group A) and 266 (84%) with no or mild aortic valve stenosis (AVA > 1.5 cm²). Patients in group A were significantly older than those in group B (78 years vs. 74 years, p value = 0.005); no other significant comorbidity differences were found between the two groups. The mean follow-up was 1178 days (SD 991 days; 2–3869 days). There were no statistically significant differences between group A and group B in terms of major amputation rate (20% vs. 16.5%; p = 0.895) and overall mortality (48.0% vs. 40.6%; p = 0.640). In the total cohort, the statistically significant variables associated with the major amputation were systemic perioperative complication (OR 5.83, 95% CI: 2.36, 14.57, p < 0.001), bypass-related complication within 30 days of surgery (OR 2.74, 95% CI: 1.17, 6.45, p = 0.020), surgical revascularization below the knee (OR 7.72, 95% CI: 1.53, 140.68, p = 0.049), and the presence of a previous cardiovascular event (OR 2.65, 95% CI: 1.14, 6.26, p = 0.024). In patients undergoing surgical revascularization for CLTI, no significant difference in major amputation rate and overall mortality was found between subjects with mild or no aortic valve stenosis and those with moderate/severe stenosis. As expected, overall mortality was higher in older patients with worse functional status. A significantly higher rate of limb amputation was found in those subjects undergoing subgenicular revascularization, early bypass failure, or previous cardiovascular event. Full article

Background: Preterm infants and their families face a challenging experience during their stay in the neonatal intensive care unit (NICU). Family-centered care emphasizes the importance of welcoming parents, involving them in their baby’s daily care, and supporting the development of parenting skills. NICU staff should support parents in understanding their baby’s needs and in strengthening the parent–infant bond. Although many tools outline what parents should learn, there is a limited structured framework to monitor their involvement in the infant’s care. Tracking parental participation in daily caregiving activities could support professionals in effectively guiding families, ensuring a smoother transition to discharge. Aims: The aim of this study was to evaluate the adherence to and effectiveness of a structured tool for parental involvement in the NICU. This tool serves several key purposes: to track the progression and timing of parents’ autonomy in caring for their baby, to support parents in building caregiving competencies before discharge, and to standardize the approach of NICU professionals in promoting both infant care and family engagement. Methods: A structured template form for documenting parental involvement (“together TO-CARE template”, TTCT) was integrated into the computerized chart adopted in the NICU of Modena. Nurses were asked to complete the TTCT at each shift. The template included the following assessment items: parental presence; type of contact with the baby (touch; voice; skin-to-skin); parental involvement in care activities (diaper changing; gavage feeding; bottle feeding; breast feeding); and level of autonomy in care (observer; supported by nurse; autonomous). We evaluated TTCT uploaded data for very low birth weight (VLBW) preterm infants admitted in the Modena NICU between 1 January 2023 and 31 December 2024. Staff compliance in filling out the TTCT was assessed. The timing at which parents achieved autonomy in different care tasks was also measured. Results: The TTCT was completed with an average of one entry per day, during the NICU stay. Parents reached full autonomy in diaper changing at a mean of 21.1 ± 15.3 days and in bottle feeding at a mean of 48.0 ± 22.4 days after admission. The mean length of hospitalization was 53 ± 38 days. Conclusions: The adoption of the TTCT in the NICU is feasible and should become a central component of care for preterm infants. It promotes family-centered care by addressing the needs of both the baby and the family. Encouraging early and progressive parental involvement enhances parenting skills, builds confidence, and may help reduce post-discharge complications and readmissions. Furthermore, the use of a standardized template aims to foster consistency among NICU staff, reduce disparities in care delivery, and strengthen the support provided to families of preterm infants. Full article

Background: Dystonic cerebral palsy (DCP) is a complex, disabling manifestation of secondary dystonia, which significantly impacts motor function, quality of life, and well-being. Conventional pharmacologic therapies frequently do not relieve symptoms sufficiently. Deep brain stimulation (DBS) of the globus pallidus internal segment (GPi) has gained increasing attention as a neuromodulatory therapy for refractory dystonia. Still, the experience of the effect of GPi DBS treatment in adults with DCP has, until recently, been limited. Methods: We performed a retrospective, two-center case series of 11 adult patients with medically refractory DCP who underwent bilateral GPi-DBS. The clinical outcomes were evaluated based on the Burke–Fahn–Marsden Dystonia Rating Scale (BFMDRS), the Functional Independence Measure (FIM), the Gross Motor Function Classification System (GMFCS), and the Caregiver Burden Scale (CBS). The assessments were done preoperatively and at 1-year follow-up. Changes in continuous variables were analyzed using paired t-tests. Results: At the 1-year follow-up, the mean BFMDRS score improved from 69.6 ± 27.6 to 54.3 ± 36.5 (p = 0.001), indicating a significant reduction in overall dystonia severity. Functional independence also improved, demonstrated by the rise in FIM scores from 65.3 ± 33.9 to 79.2 ± 43.4 (p = 0.006). Although GMFCS levels did not change in most patients (p = 0.125), the burden on caregivers decreased significantly, with CBS scores falling from 35.7 ± 18.8 to 32.0 ± 17.1 (p = 0.015). There were no surgical complications. Conclusions: In adults, bilateral GPi-DBS is a safe and effective intervention for DCP, improving motor control and increasing functional independence while decreasing caregiver burden. These findings lend support to its role in the multidisciplinary management of DCP. Full article

Background: In clinical practice, visual outcomes with anti-VEGF therapy may be worse than those observed in clinical trials. In this study, we aim to investigate the long-term outcomes of neovascularization treated with intravitreal aflibercept injections (IAI) in a teaching hospital setting. Methods: This is a retrospective, single-center study including 81 nAMD patients (116 eyes), those both newly diagnosed and switched from ranibizumab. All patients had a follow-up duration of at least seven years. Treatment involved three monthly injections followed by either a pro re nata (PRN) or treat and extend regimen. Follow-up care was primarily conducted by training physicians. The primary endpoint was the change in best-corrected visual acuity (BCVA) over seven years. Secondary endpoints included central retinal thickness changes, qualitative OCT parameters, macular atrophy progression, injection frequency, and treatment adherence. Results: Among the 116 eyes, 52 (44.8%) completed the seven-year follow-up. Visual acuity improved by +2.1 letters in the overall population (+6.3 letters in treatment-naive eyes) after the loading phase but gradually declined, resulting in a loss of −12.3 letters at seven years. BCVA remained stable (a loss of fewer than 15 letters) in 57.7% of eyes. Central retinal thickness (CRT) decreased significantly during follow-up in both naive and switcher eyes. Macular atrophy occurred in 94.2% of eyes, progressing from 1.42 mm² to 8.55 mm² over seven years (p < 0.001). The mean number of injections was 4.1 ± 1.8 during the first year and 3.7 per year thereafter. Advanced age at diagnosis was a risk factor for loss to follow-up, with bilaterality being a protective factor against loss to follow-up (p < 0.05). Conclusions: This study highlights the challenges faced by a retina clinic in a teaching hospital. Suboptimal functional and anatomical outcomes in real life may derive from insufficient patient information and inconsistent monitoring, which contributes to undertreatment and affects long-term visual outcomes. It also raises concerns about supervision in a teaching hospital which needs to be improved. Full article

Background: Regulatory T cells (Tregs) are the main suppressor cells that maintain immune tolerance and prevent autoimmunity. Changes in Treg number or function are implicated in a wide range of autoimmune and inflammatory (AI/I) diseases, with or without underlying inborn errors of immunity (IEI). Understanding the phenotypic profiles of Treg subsets and their associations with immune dysregulation is crucial to identifying potential robust and holistic biomarkers for disease activity. Methods: We examined peripheral blood mononuclear cells from 40 patients diagnosed with various autoimmune/inflammatory diseases, including those with genetically confirmed inborn errors of immunity (IEIs), and compared these samples to those from 38 healthy controls of the same age. Utilizing multiparametric flow cytometry, we measured multiple Treg sub-populations and investigated their correlations with lymphocyte subset profiles and the diversity of autoantibodies. We applied advanced statistical and machine learning techniques, such as t-SNE, k-means clustering, and ROC analysis, to analyze immunophenotypic patterns in the patients. Results: Among all Treg sub-populations, only CD4⁺CD127^lowCD25^highFOXP3⁺ Tregs showed a significant decrease in patients compared to healthy controls (p < 0.05), while other Treg phenotypes did not differ. FOXP3 expression showed reduced intensity in patients and demonstrated diagnostic potential (AUC = 0.754). Notably, this Treg subset negatively correlated with CD19⁺ B cell percentages and positively correlated with the diversity of circulating autoantibodies. Unsupervised clustering revealed three distinct immunophenotypic profiles, highlighting heterogeneity among patients and underlining FOXP3-centered immune dysregulation. Conclusions: Our results presented that patients have an impairment in the CD4⁺CD127^lowCD25^highFOXP3⁺ regulatory T cell subset, which is identified by significantly decreased frequency and decreased expression of FOXP3. Immunological heterogeneity among patients was further uncovered by unsupervised clustering, highlighting the critical role that FOXP3-centered regulatory failure plays in the pathophysiology of illness. The combined evaluation of these three immunological factors, centered around FOXP3, holds promise as an integrative tool for monitoring disease progression across various autoimmune and immunodeficient contexts. Full article

Durum wheat, the world’s second most cultivated wheat species, is a staple crop, critical for global food security, including in Ethiopia where it serves as a center of diversity. However, climate change and genetic erosion threaten its genetic resources, necessitating genomic studies to support conservation and breeding efforts. This study characterized genome-wide diversity, population structure (STRUCTURE, principal coordinate analysis (PCoA), neighbor-joining trees, analysis of molecular variance (AMOVA)), and selection signatures (F_ST, Hardy–Weinberg deviations) in Ethiopian durum wheat by analyzing 376 genotypes (148 accessions) using an Illumina Infinium 25K single nucleotide polymorphism (SNP) array. A set of 7842 high-quality SNPs enabled the assessments, comparing landraces with cultivars and breeding populations. Results revealed moderate genetic diversity (mean polymorphism information content (PIC) = 0.17; gene diversity = 0.20) and identified 26 loci under selection, associated with key traits like grain yield, stress tolerance, and disease resistance. AMOVA revealed 80.1% variation among accessions, with no significant differentiation by altitude, region, or spike density. Landraces formed distinct clusters, harboring unique alleles, while admixture suggested gene flow via informal seed exchange. The findings highlight Ethiopia’s rich durum wheat diversity, emphasizing landraces as reservoirs of adaptive alleles for breeding. This study provides genomic insights to guide conservation and the development of climate-resilient cultivars, supporting sustainable wheat production globally. Full article

In 2023, the USDA reported that 17.9% of U.S. households with children were food insecure, meaning they had limited or uncertain access to adequate food. However, there is evidence that far more children experience food insecurity than is currently being reported, and the effects of that insecurity on child health and development are broad and far-reaching. Childcare and early childhood education centers are particularly well-positioned to make a difference yet are often not discussed in the scientific literature. Childcare arrangements provide meals and snacks to the children they serve, buffer the effects of food insecurity by supporting children’s cognitive and social–emotional development, and provide an important point of intervention for food-insecure families. In this report, we unpack the definition of food insecurity and who is considered food insecure, review how food insecurity impacts child health and development across physical, social–emotional, and cognitive domains, and explore the evidence behind childcare’s role in addressing childhood food insecurity. Additionally, we make recommendations for policy and practice, advocating for a multi-stakeholder approach, with a special focus on how childcare providers can change to best combat children’s food insecurity. Full article

Background and Objectives: Type 2 diabetes (T2D) is a global health burden with increasing prevalence, necessitating effective management strategies. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have emerged as beneficial therapies, promoting both glycemic control and weight loss, yet real-world data on sex differences in response are limited. This study aimed to investigate sex-based differences in glycemic and weight outcomes, as well as adverse effects, in T2D patients treated with GLP-1 RAs at a single diabetes center. Materials and Methods: In this retrospective analysis, 114 patients (58.8% men) with T2D who were initiated on GLP-1 RA therapy between 2015 and 2023 were evaluated. Data on HbA1c, BMI, and adverse events were collected at baseline and 3, 6, and 12 months post-treatment initiation. Results: Our findings indicated a statistically significant HbA1c reduction (from 8.6% at GLP-1 RA initiation to 6.9% at 12 months in men (p < 0.001) and from 8.4% at initiation to 7.0% at 12 months after GLP-1 RA initiation (p < 0.001) in women). By 12 months, a significantly greater proportion of women compared to men achieved ≥ 5% (51.1% vs. 28.4%, p = 0.019) and ≥10% weight loss (29.8% vs. 9.0%, p = 0.006), with both differences reaching statistical significance. A statistically significant difference in weight loss in mean weight change and percent weight change in men vs. women was observed from month 6 of therapy. Conclusions: These findings underscore the effectiveness of GLP-1 RAs in improving glycemic control and weight loss in a real-world setting and suggest that women may experience greater weight reduction. Understanding these differences could inform personalized treatment strategies for optimized outcomes in T2D management. Full article

This article presents an initial effort to systematize two interrelated research fronts within ecological economics (EE): ecological microeconomics and ecological macroeconomics. In response to the field’s transdisciplinary and plural nature—attributes that, while enriching, may limit its political influence—the article proposes a conceptual delineation of these two domains as a means to strengthen EE’s analytical identity and facilitate dialogue with other economic approaches. Ecological microeconomics focuses on the material and energy intensity of economic activity, the complementarity of natural capital in production processes, and the redesign of consumption and firm behavior under ecological constraints. Ecological macroeconomics, in turn, centers on the biophysical limits to growth, the concept of sustainable and optimal scale, and the integration of environmental variables into macroeconomic indicators and policy frameworks. The article argues that both fronts, despite their distinct emphases, are united by the need for long-term structural change and a normative commitment to sustainability. Together, they offer a coherent basis for rethinking prosperity within the ecological boundaries of the Earth system. Full article

Background/Objectives: Adherence to oral endocrine therapy (OET) is essential to reduce recurrence but is predominantly lower among underserved patients, leading to worse health outcomes. We aimed to depict longitudinal patterns of OET adherence using group-based trajectory modeling (GBTM) and identify predictors associated with each adherence trajectory. Methods: A single-center, retrospective study was conducted to analyze data from women 18 years or older with metastatic breast cancer who initiated with an OET and were treated from January to December 2022. Adherence was measured using a proportion of days covered (PDC > 80%) for 12 months. Binary monthly indicator of PDC was incorporated into GBTM. Four models were generated by changing the number of groups from 2 to 5, using a 2nd-order polynomial function of time. A multinomial logistic regression model was run to evaluate the predictors of non-adherence trajectories, and “adherence” was considered the reference group. Results: A total of 346 women had a (mean age of 60) years; 93% were Hispanic or of Mexican origin; 90% were taking aromatase inhibitors (AIs), with an endocrine therapy of 1.05 years. Three trajectories of adherence to GBTM were identified: a gradual decline in adherence (n = 88, 25.5%), improving suboptimal adherence (n = 106, 30.6%), and adherent (n = 152, 43.9%). Multinomial logistic regression analysis showed that significant predictors are diabetes (odds ratio (OR), 2.96; 95% confidence interval (CI), 1.57–5.57) and fewer years of therapy (OR, 2.96; 95% CI, 1.57–5.57). Suboptimal adherence among RGV patients receiving OET, with approximately 56% following a non-adherent trajectory. Conclusions: Suboptimal adherence among RGV patients receiving OET, with approximately 56% following a non-adherent trajectory. Significant predictors should be considered when designing targeted interventions. Full article