Search Results (2,206)

Severe mitral regurgitation (MR) is one of the most common valvular heart diseases and is frequently associated with advanced left ventricular (LV) systolic dysfunction. Transcatheter edge-to-edge repair (TEER) offers effective symptom relief but may induce abrupt hemodynamic changes leading to afterload mismatch and acute LV failure. Levosimendan may help mitigate this complication by improving contractility, yet evidence supporting its use in this setting is scarce. Therefore, the aim of this study was to systematically evaluate the evidence on the effects of Levosimendan in patients with severe MR and LV dysfunction undergoing TEER. We performed a comprehensive search of PubMed, Embase, Scopus, and Google Scholar. Primary outcomes were postprocedural LV ejection fraction (LVEF) and systolic pulmonary artery pressure (sPAP). Secondary outcomes included procedural success, procedure duration, and in-hospital complications. Five studies comprising 315 patients (n = 141 Levosimendan, n = 174 controls) met the inclusion criteria. Pooled analysis showed no significant difference in postprocedural LVEF between Levosimendan-treated patients and controls (mean difference 0.45%, 95% CI [−1.46–2.35] p = 0.65) and no significant change from baseline. Similarly, postprocedural sPAP did not differ significantly. Procedural success was higher with Levosimendan, and procedure duration was shorter. These hypothesis-generating findings highlight the need for larger, prospective randomized trials to clarify the role of Levosimendan in this setting. Full article

Background/objectives: Metabolic abnormalities, independent of excess weight, may contribute to cancer risk even among individuals of normal weight, though their role remains unclear. This study sought to ascertain if metabolically unhealthy normal-weight (MUNW) individuals, generally characterized by a normal body mass index alongside the presence of metabolic abnormalities, have higher cancer risk than metabolically healthy peers, to analyze variations in risk across obesity-related cancer types, and to examine which single specific metabolic components can predict cancer independently in normal-weight individuals. Methods: Two authors systematically searched the PubMed, EMBASE, and Web of Science databases for longitudinal studies, published from inception to July 2025, that included normal-weight adults, classified participants by metabolic health status, and reported incident cancer outcomes in metabolically unhealthy versus healthy normal-weight groups. Hazard ratio (HR) estimates were extracted from each study and were pooled using random-effects inverse-variance model with empirical Bayes variance estimator. Results: Thirty-five studies involving 18,210,858 participants (56.0% females, mean age = 53.8 years) were included. A total of 280,828 new cancer cases were diagnosed during follow-up (mean = 10.6 years). In comparison with metabolically healthy normal-weight individuals, MUNW individuals had a 20% higher risk of cancer (HR = 1.20, 95% confidence interval [CI]: 1.13–1.28). Increased risks were observed for gastric cancer (HR = 1.40, 95% CI: 1.04–1.87), pancreatic cancer (HR = 1.37, 95% CI: 1.21–1.54), and colorectal cancer (HR = 1.34, 95% CI: 1.14–1.57), which were the cancer types showing statistically significant associations in subgroup analyses. Normal-weight participants presenting specific metabolic factors like central adiposity or glucose metabolism abnormalities had a 20% (HR = 1.20, 95% CI: 1.13–1.37) and 23% (HR = 1.23, 95% CI: 1.06–1.41) increased cancer risk, respectively. Conclusions: MUNW individuals are at higher risk of cancer, with specific metabolic abnormalities, particularly central adiposity and impaired glucose regulation, emerging as the factors most strongly associated with increased risk in normal-weight individuals. Routine metabolic screening and detailed phenotyping are crucial to identify these risks. Full article

Ericksonian hypnotherapy (EH), a client-centered hypnotic approach characterized by indirect suggestion, individualized flexibility, collaboration, and the principle of Utilization, has seen increased interest as a therapeutic modality across diverse clinical settings. This systematic review and meta-analysis aimed to evaluate the efficacy of EH by synthesizing evidence from randomized controlled trials (RCTs) published between 2015 and 2025. Eight eligible RCTs (N = 676) were identified, spanning conditions such as acute pain, depression, grief, irritable bowel syndrome, disordered eating, and alcohol use. EH interventions consistently produced significant symptom reductions compared to waitlists or standard care, with a pooled standardized mean difference of 1.17 (95% CI: 0.70–1.64), indicating a large effect. Moreover, trials comparing EH to active treatments (e.g., CBT, motivational interviewing) revealed comparable efficacy, with pooled estimates supporting non-inferiority. Sensitivity analyses confirmed the robustness of these findings. Notably, some trials suggested that the indirect and personalized nature of EH may confer advantages in domains like grief and hypervigilance. Although evidence remains limited by sample size and heterogeneity, this review provides initial empirical support for EH and supports its inclusion in the evidence-based repertoire for both physical and psychological conditions. Future research should examine mechanisms of change and individual predictors of response to optimize the use of this distinctive hypnotic style. Full article

Intermittent claudication (IC) is the most frequent symptomatic manifestation of lower-extremity peripheral artery disease (PAD). Supervised exercise therapy (SET) and endovascular revascularization (ER) are established treatments, but their relative and combined effects on health-related quality of life (HRQoL) remain. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing SET, ER, and ER+SET, with HRQoL as the primary outcome. Methods: Following PRISMA 2020, PubMed, Embase, and CENTRAL were used in December 2024. Eligible RCTs enrolled with IC (excluding critical limb-threatening ischemia) and reported validated HRQoL outcomes at ≥3 months. Two reviewers independently extracted data and assessed risk of bias using the Cochrane RoB 2.0 tool. Random-effects meta-analyses pooled standardized mean differences (SMDs) for HRQoL and mean differences (MDs) for walking distance. Results: Five RCTs (n = 728) were included. Compared with optimal medical therapy, both SET and ER improved HRQoL and walking distance. At 12 months, no significant effect was observed between SET and ER (SMD 0.02; 95% CI: −0.18 to 0.22). ER+SET was superior to SET alone (SMD 0.35; 95% CI: 0.12–0.57). Beyond 24 months, improvements were sustained with SET but attenuated with ER, accompanied by higher reintervention rates in ER-containing arms (approximately 20–30% by 2 years). Adverse events were rare (<1%). Conclusions: Given moderate-certainty evidence (GRADE), SET should remain the first-line therapy for intermittent claudication because it provides durable improvements in patient-centered outcomes with minimal harm. Endovascular revascularization (ER) can provide faster symptom relief, but its long-term benefits are constrained by restenosis and repeat procedures, particularly in femoropopliteal disease. Full article

This study examines global econo-environmental capability for 118 countries over 1995 to 2024 using a five-lens framework covering productive capacity (PC), developmental momentum (DM), resource efficiency (RE), degradation and depletion ratio (DDR), and remaining development potential (RDP). Using pooled k-means, a stable four archetype typology is identified and shown to persist over time. The analysis assesses how archetypes characterize country–year outcomes (RQ1), whether cross-sectional fairness is changing and relates to frontier slowdown (RQ2), and how archetypes, distance, and regional context shape transition probabilities and club convergence (RQ3). Inequality in five-dimensional capability declines slightly over the period (Gini from 0.109 to 0.092 and Palma from 1.563 to 1.464), implying modest convergence rather than increasing polarization. Average capability also improves, with larger gains for initially distant countries and smaller gains near the frontier, which is consistent with mild club convergence. Regionally, high capability cases are concentrated in Western Europe and North America, while sustained upgrading is observed in parts of Eastern Europe, mixed stability is observed in East and Central Asia, and selective advances are observed in ASEAN. Policy implications should be based on a country’s archetype and its distance to the capability ideal. Lagging countries should prioritize diffusion of proven high efficiency options and basic capability building, while frontier countries should priorities innovation, structural change, and deeper decarbonization. Policy emphasis should be updated as countries move within the capability space over time. Full article

Background: Identifying factors associated with cognitive impairment among older adults is critical. This study investigates both concurrent and longitudinal associations between sleep quality, sleep duration, and cognitive performance among older adults in China, with particular emphasis on the moderating role of fruit and/or vegetable intake (FVI), a factor rarely examined in previous research. Methods: We pooled five waves of a specially designed nationwide sample of adults aged 65 years or older (N = 64,690; mean age: 86.3 years; men: 43.5%) in 2005, 2008, 2011, 2014, and 2018 in China. Cognitive impairment was assessed by the Mini-Mental State Examination. Among the sample, 10.7% were cognitively impaired. FVI was dichotomized into frequent (almost daily) versus infrequent (other low frequencies). Sleep hours were grouped into short (≤6 h), normal (7–9 h), and long (≥10 h) durations. Both concurrent and cross-lagged analyses were performed after adjusting for a wide set of covariates (demographics, socioeconomic status, family/social connections, health practices, disability, self-rated health, and chronic conditions). Analyses were further stratified by gender, age group, and urban–rural residence. Results: When all covariates were present (the full model), good sleep quality was associated with 22% lower odds of the prevalence of cognitive impairment, whereas the long sleep duration was associated with 24% higher odds as compared with the normal sleep duration. Although the short sleep duration was not associated with the prevalence of cognitive impairment in the full model, it was associated with 8% higher odds of cognitive impairment when health condition was not controlled for. Interaction analyses revealed that frequent FVI buffered the adverse cognitive effects of poor sleep quality and both short and long sleep durations. Subgroup analyses further show similar patterns across subpopulations, with more pronounced protective associations in older women and the oldest-old. Conclusions: Good sleep quality, normal sleep durations, and frequent FVI jointly contribute to better cognitive functioning at older ages. While the observed relationships are largely concurrent rather than causal, promoting both healthy sleep and dietary habits may be important for cognitive health among older adults. Full article

This study examines the association between financial structure components—financial access, depth, and efficiency—technological innovation, and environmental pressure in the European Union over the period 1992–2021, with the EU energy transition serving as the broader policy context. To capture the multidimensional nature of environmental pressure, a composite Environmental Pressure Index (EPI) is constructed using Principal Component Analysis (PCA), integrating indicators of air pollution, biocapacity, ecological footprint, and income-related economic activity. Employing a Pooled Mean Group (PMG) estimator within a panel ARDL framework, the results indicate that financial access is positively associated with environmental pressure in both the short and long run, whereas financial depth and financial efficiency are linked to lower environmental pressure over the long term. Technological innovation exhibits a time-varying relationship: innovation-related activities are associated with higher environmental pressure in the short run, reflecting transitional adjustment costs, but with reduced pressure in the long run as cleaner and more efficient technologies diffuse. Urbanization and population growth are also found to contribute positively to environmental pressure, pointing to persistent demographic challenges within the EU. From a policy perspective, the findings highlight the importance of aligning financial governance with the objectives of the European Green Deal by incorporating environmental efficiency considerations into credit allocation, supporting innovation-oriented investments, and promoting integrated spatial and environmental planning. Overall, the study suggests that coordinated financial development and innovation policies can contribute to mitigating environmental pressure in the European Union over time. Full article

Background/Objective: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) exhibit neuroprotective properties in preclinical models of Alzheimer’s disease (AD), reducing amyloid accumulation, neuroinflammation, and insulin resistance within the brain. However, clinical evidence regarding their cognitive effects in AD and mild cognitive impairment (MCI) remains inconclusive. To evaluate the effects of GLP-1 RAs on cognitive outcomes in patients with AD or MCI due to AD. Methods: A systematic review was conducted according to PRISMA 2020 and registered in PROSPERO (CRD420251143171). Although the original registry was broad, the identification of a small set of homogeneous randomized controlled trials (RCTs) during screening, prior to data extraction, allowed for a random-effects meta-analysis of cognitive outcomes. RCTs enrolling adults with clinically or biomarker-confirmed AD or MCI were included. Interventions comprised liraglutide or exenatide compared with placebo. Standardized mean differences (SMD) in global cognitive scores were pooled using a random-effects model (restricted maximum likelihood [REML] estimator with Hartung–Knapp adjustment). Results: Three randomized trials (n = 278 participants; 51% women; mean age 68 ± 7 years) met inclusion criteria. Treatment duration ranged from 26 weeks to 18 months. Pooled analysis revealed no significant effect of GLP-1 RAs on global cognition compared with placebo −0.21 (95% CI −0.81 to 0.38; I² = 47%; τ² = 3.77). Sensitivity analyses restricted to liraglutide or studies ≥ 12 months yielded similar results. Conclusions: Current randomized evidence does not support cognitive improvement with GLP-1 RAs in AD or MCI. Full article

Background and Objectives: Effective pain control after laparoscopic colorectal surgery is crucial for Enhanced Recovery After Surgery (ERAS) protocols. The transversus abdominis plane block (TAPB) provides somatic analgesia but lacks visceral coverage. The quadratus lumborum block (QLB) has emerged as an alternative, potentially offering both somatic and visceral blockade, but its superiority is debated. This systematic review and meta-analysis aimed to compare the analgesic efficacy of QLB versus TAPB in this setting. Materials and Methods: A comprehensive search of PubMed, Scopus, CENTRAL, and Web of Science was conducted for randomized controlled trials (RCTs) up to November 2025. Primary outcomes were 24 h postoperative and intraoperative opioid consumption. Secondary outcomes included pain scores, length of hospital stay (LoS), surgery duration, and adverse events. Standardized mean differences (SMD) and risk ratios (RR) were pooled. Results: Five RCTs involving 520 patients were included. No significant difference was found in 24 h postoperative opioid consumption (SMD: −1.62, 95% CI [−3.45, 0.20]; p = 0.08) or intraoperative opioid consumption (SMD: 0.38, 95% CI [−0.36, 1.12]; p = 0.31). QLB provided better, transient pain relief at rest at 12 h (SMD: −0.30, 95% CI [−0.52, −0.07]; p = 0.01) and during movement at 6 h (SMD: −0.20, 95% CI [−0.49, −0.09]; p = 0.01). No other time points for pain showed significant differences. QLB was associated with a shorter surgery duration (MD: −5.61 min, 95% CI [−10.38, −0.85]; p = 0.02), but not LoS (p = 0.53) or rates of PONV (p = 0.24) or dizziness (p = 0.32). Conclusions: With uncertain evidence, QLB and TAPB showed no significant difference in opioid consumption. QLB demonstrated a statistically significant but transient early analgesic advantage. This heterogeneity may be due to different QLB techniques, warranting further investigation. Full article

Background and Objectives: We aimed to evaluate the effectiveness of virtual reality (VR) therapy compared with conventional rehabilitation on static postural control and dynamic balance in patients with stroke. Design: A systematic review and meta-analysis of randomized controlled trials (RCTs) were conducted in accordance with the PRISMA 2020 guidelines. Materials and Methods: RCTs involving adults with stroke who received VR-based interventions, alone or combined with conventional therapy, were included. Outcomes were static postural control measured by center of pressure (COP) and dynamic balance assessed by the Berg Balance Scale (BBS) and Timed Up-and-Go Test (TUG). Results: Thirty-six RCTs (1118 participants) were analyzed. Pooled estimates favored VR-based interventions for several measures of static postural control, with standardized mean differences ranging from −0.59 to −0.38 (p < 0.05), whereas no clear difference was observed for COP sway speed under eyes-closed conditions (standardized mean difference (SMD) = –0.13, p = 0.43). For dynamic balance outcomes, pooled mean differences favored the VR group compared with conventional rehabilitation (BBS: mean difference (MD) = 3.29, 95% CI 2.76–3.83; TUG: MD = −3.43, 95% CI −4.03 to −2.82; both p < 0.0001). However, substantial heterogeneity and a high risk of bias were observed across several outcomes, which may affect the certainty of these findings. Conclusions: VR-based interventions may offer potential benefits for improving static postural control and dynamic balance in individuals with stroke, particularly when used as an adjunct to conventional rehabilitation. Nevertheless, given the substantial heterogeneity and risk of bias among included studies, the findings should be interpreted cautiously, and further well-designed, large-scale trials are required to confirm the magnitude and clinical relevance of these effects. Full article

Background: Total hip arthroplasty (THA) is a well-tolerated and effective procedure that can improve a patient’s mobility and quality of life. A main concern, however, is the release of metal ions into the body due to wear and corrosion. Commonly reported ions are Co and Cr, while others, such as Ti, Mo, and Ni, are less frequently studied. The objective of this study was to characterize compartmentalization and time-dependent ion behaviors across serum, whole blood, and urine after hip prosthetic implantation. The goal of using Random Forest (RF) was to determine whether machine learning modeling could support temporal trends across data. Methods: Data was gathered from the literature of clinical studies, and we conducted a pooled analysis of the temporal kinetics from cohorts of patients who received hip prosthetics. Mean ion concentrations were normalized to µg/L across each fluid and weighted by cohort sample size. RF was used as a study-level test of predictive accuracy across ions. Results: For serum and whole blood, Co and Cr displayed one-phase association models, while Ti showed an exponential rise and decay. Ions typically rose quickly within the first 24 months postoperatively. Serum Co and whole blood had similar patterns, tapering off just under 2 µg/L, but serum Cr (~2.02 µg/L) was generally higher than that of whole blood (~0.99 µg/L). Mean urinary Co levels were greater than those of Cr, suggesting a larger, freely filterable fraction for Co. RF was implemented to determine predictive accuracy for each ion, showing a stronger fit for Co (R² = 0.86, RMSE = 0.57) compared to Cr (R² = 0.52, RMSE = 0.50). Conclusions: Sub-threshold exposure was prevalent across cohorts. Serum and whole blood Co and Cr displayed distinct kinetic profiles and, if validated, could support fluid-specific monitoring strategies. We present a methodology for interpreting ion kinetics and show potential for machine learning applications in postoperative monitoring. Full article

Background: Fine particulate matter (PM_2.5) is an established systemic toxicant, yet its association with clinical skin aging remains incompletely characterized. Although pigmentary changes and wrinkles are commonly attributed to ultraviolet exposure, experimental and epidemiologic evidence suggests that long-term PM_2.5 exposure may contribute to extrinsic skin aging through oxidative, inflammatory, and aryl hydrocarbon receptor-mediated pathways. However, human studies specifically quantifying PM_2.5 exposure in relation to validated skin aging outcomes are sparse, and no prior meta-analysis has systematically synthesized this evidence. Objective: To conduct a systematic review and meta-analysis of epidemiologic studies reporting measured or modeled long-term PM_2.5 exposure and extractable quantitative associations with clinical skin aging outcomes. Methods: We performed a comprehensive PRISMA 2020-guided search of PubMed, Embase, Web of Science, and Scopus (inception to 18 November 2025). Eligible studies included human participants, quantified long-term PM_2.5 exposure, validated clinical or imaging-based skin aging outcomes, and extractable effect estimates. Ratio-type effect measures (arithmetic mean ratios, geometric mean ratios, and odds ratios) were transformed to the natural-log scale, standardized to a common exposure contrast of per 10 µg/m³ PM_2.5, and synthesized as generic relative association metrics. Random-effects models with DerSimonian–Laird estimation and Hartung–Knapp adjustment were applied for pigmentary outcomes. VISIA imaging β-coefficients were synthesized narratively. Results: Four epidemiologic cohorts met predefined eligibility criteria. From these, we extracted seven PM_2.5-specific pigmentary effect estimates, one clinically assessed wrinkle estimate, and two VISIA imaging outcomes. The pooled relative association for pigmentary aging corresponded to a ratio of 1.11 per 10 µg/m³ PM_2.5 (95% CI, 0.82–1.50), indicating a directionally positive but statistically imprecise association compatible with both increased and unchanged pigmentary aging. All individual pigmentary estimates were directionally positive. A single cohort reported a 3.2% increase in wrinkle severity per 10 µg/m³ PM_2.5 (ratio 1.032). VISIA imaging showed significant worsening of brown spot severity (+9.5 percentile per 10 µg/m³), while wrinkle percentiles showed a non-significant change. Conclusions: Based on a comprehensive PRISMA-guided search, the available epidemiologic evidence suggests a consistent directionally positive association between long-term PM_2.5 exposure and pigmentary skin aging outcomes, with limited and uncertain evidence for wrinkle-related phenotypes. The current evidence base remains small, heterogeneous, and of low certainty. Accordingly, these findings should be interpreted as hypothesis-generating and underscore the need for larger, longitudinal, and methodologically harmonized studies. (Registration: PROSPERO CRD420251231462) Full article

The quality of sustainability reporting (SR) has come to be widely regarded as a factor of considerable importance in influencing organisational performance. However, empirical evidence in relation to SR has been characterised by fragmentation across industrial sectors. The purpose of this study was to synthesise the relationship between SR and organisational performance across the manufacturing, finance, energy and utilities, services, and ICT sectors. Our systematic review, performed using the PRISMA 2020 framework and machine learning meta-regression, was conducted on 372 studies retrieved from the Scopus database between 1 January 2020 and 1 November 2025. Our pooled correlation showed that the SR effect was positively associated with outcome performance (r = 0.231, 95% CI [0.184, 0.279]) and yielded a standardised mean difference (g = 0.426, 95% CI [0.341, 0.512]). The meta-regression showed that assurance quality (β = 0.156, p < 0.001), the regulatory regime (β = 0.142, p < 0.001), and reporting standard alignment (β = 0.118, p = 0.003) are significant moderating factors. The predictive robustness was confirmed through cross-validation (R² = 0.55; RMSE = 0.056), while feature stability was substantiated by a mean SHAP variance of less than 0.012. Transparency, comparability, and decision usefulness in SR were found to be enhanced by institutional mechanisms—particularly those providing credible assurance within mandatory regulatory frameworks. Full article

Piggery farming is the largest source of livestock manure in South Korea, yet greenhouse gas (GHG) data from piggery wastewater treatment systems remain limited. This study quantified methane (CH₄) and nitrous oxide (N₂O) fluxes from a full-scale treatment facility to develop stage-, seasonal-, and diurnal-specific emission factors. Continuous laser-based monitoring using a PVC air-pool chamber was applied across raw wastewater storage, an anoxic nitrogen-conversion reactor, and strongly aerated nitrification units. Mean CH₄ fluxes ranged from 1.1 to 15.6 mg s⁻¹ m⁻² peaking in summer, while N₂O fluxes ranged from 0.01 to 17,971 mg s⁻¹ m⁻², with maxima in fall. Emissions were dominated by two functional zones: aerated basins where vigorous mixing enhanced CH₄ stripping, and an upstream anoxic reactor where oxygen instability and nitrite accumulation produced extreme N₂O peaks. Derived emission factors were 0.11 kg CH₄ head⁻¹ yr⁻¹ and 45.2 kg N₂O head⁻¹ yr⁻¹, equivalent to 3.1 and 12,300 kg CO₂-eq head⁻¹ yr⁻¹. CH₄ variability was controlled mainly by treatment stage and temperature, whereas N₂O was governed by internal redox conditions. These results refine emission factors for inventories and underscore the need for improved aeration stability and denitrification control to reduce GHG emissions from piggery wastewater systems. Full article

Background: Accurate recognition of promoter sequences in Escherichia coli is fundamental for understanding gene regulation and engineering synthetic biological systems. However, existing computational methods struggle to simultaneously model long-range genomic dependencies and fine-grained local motifs, particularly the degenerate −10 and −35 elements of $\sigma 70$ promoters. To address this gap, we propose DNABERT2-CAMP, a novel hybrid deep learning framework designed to integrate global contextual understanding with high-resolution local motif detection for robust promoter identification. Methods: We constructed a balanced dataset of 8720 experimentally validated and negative 81-bp sequences from RegulonDB, literature, and the E. coli K-12 genome. Our model combines a pre-trained DNABERT-2 Transformer for global sequence encoding with a custom CAMP module (CNN-Attention-Mean Pooling) for local feature refinement. We evaluated performance using 5-fold cross-validation and an independent external test set, reporting standard metrics including accuracy, ROC AUC, and Matthews correlation coefficient (MCC). Results: DNABERT2-CAMP achieved 93.10% accuracy and 97.28% ROC AUC in cross-validation, outperforming existing methods including DNABERT. On an independent test set, it maintained strong generalization (89.83% accuracy, 92.79% ROC AUC). Interpretability analyses confirmed biologically plausible attention over canonical promoter regions and CNN-identified AT-rich/-35-like motifs. Conclusions: DNABERT2-CAMP demonstrates that synergistically combining pre-trained Transformers with convolutional motif detection significantly improves promoter recognition accuracy and interpretability. This framework offers a powerful, generalizable tool for genomic annotation and synthetic biology applications. Full article