Search Results (726)

The administration of enteral nutritional therapy (ENT), combined with the use of probiotics, is considered a proactive therapeutic strategy that can modulate the intestinal microbiota, resulting in beneficial effects on intestinal integrity and function, as well as on the immune system of patients. This review aimed to find evidence on the clinical effects of probiotic administration in treating patients using ENT. An integrative search was performed to select scientific articles on the use of probiotics in ENT published in the last 10 years (2014–2025) using PubMed, ScienceDirect, Scielo, and Google Scholar databases. The descriptors used in the search were “probiotics” AND “enteral nutrition” OR “tube feeding” AND “adults” AND “critical illness”. Retrospective studies, pilot single/double-blind placebo-controlled clinical trials, and randomized trials investigating the effects of probiotic supplementation in enteral nutrition were included. A review of 21 manuscripts was conducted, in which all patients received ENT with probiotics, with 14 monitored in the ICU, 4 in the ward, and 3 at home. All 21 studies reviewed included a control group using enteral nutrition alone or a placebo, and some also included the study of other treatments. All studies demonstrated clinical benefits of some nature for patients who received enteral nutrition associated with the use of probiotics, such as reduced hospitalization time, improvement in the gastrointestinal tract, reduction in diarrhea associated with the use of antibiotics and inflammatory and immunological responses, and reduction in the incidence of pneumonia associated with mechanical ventilation. Probiotic supplementation in adult patients using enteral nutritional therapy demonstrates benefits that help promote health and improve intestinal microbiota composition. No side effects or adverse risks have been reported. Full article

Natural cooling and ventilation have been fundamental principles in vernacular architecture for millennia, shaping sustainable building practices across diverse climatic regions. This paper examines the historical evolution, technological advancements, environmental benefits, and prospects of passive cooling strategies, with a particular focus on wind catchers. Originating in Mesopotamian, Egyptian, Caucasia, and Iranian architectural traditions, these structures have adapted over centuries to maximize air circulation, thermal regulation, and humidity control, ensuring comfortable indoor environments without reliance on mechanical ventilation. This study analyzes traditional wind catcher designs, highlighting their geometric configurations, airflow optimization, and integration with architectural elements such as courtyards and solar chimneys. Through a comparative assessment, this paper contrasts passive cooling systems with modern HVAC technologies, emphasizing their energy neutrality, low-carbon footprint, and long-term sustainability benefits. A SWOT analysis evaluates their strengths, limitations, opportunities for technological integration, and challenges posed by urbanization and regulatory constraints. This study adopts a comparative analytical method, integrating a literature-based approach with qualitative assessments and a SWOT analysis framework to evaluate passive cooling strategies against modern HVAC systems. Methodologically, the research combines historical review, typological classification, and sustainability-driven performance comparisons to derive actionable insights for climate-responsive design. The research is grounded in a comparative assessment of traditional and modern cooling strategies, supported by typological analysis and evaluative frameworks. Looking toward the future, the research explores hybrid adaptations incorporating solar energy, AI-driven airflow control, and retrofitting strategies for smart cities, reinforcing the enduring relevance of vernacular cooling techniques in contemporary architecture. By bridging historical knowledge with innovative solutions, this paper contributes to ongoing discussions on climate-responsive urban planning and sustainable architectural development. Full article

Background and Aim: Mechanical ventilatory support is often required in patients with acute respiratory distress syndrome (ARDS). However, early differences in ventilatory mechanics and severity scores between COVID-19 and non-COVID-19 ARDS patients remain unclear. This study aimed to compare respiratory parameters and clinical severity scores in COVID-19 and non-COVID-19 ARDS patients managed in the emergency department (ED) and evaluate their association with in-hospital mortality. Methods: In this retrospective cohort study, adult patients with ARDS (PaO₂/FiO₂ < 300 mmHg) who received mechanical ventilation in the ED were included. Ventilator parameters and clinical severity scores (SOFA, APACHE II, PSI, and Charlson Comorbidity Index) were recorded at the 120th minute after intubation. Patients were categorized as COVID-19 or non-COVID-19 ARDS, and outcomes were compared between survivors and non-survivors. Logistic regression was used to identify independent predictors of in-hospital mortality. Results: A total of 70 patients were enrolled (32 COVID-19, 38 non-COVID). Plateau pressure, driving pressure, and PEEP were significantly higher in COVID-19 patients, while compliance was without statistical significance. Overall, in-hospital mortality did not differ significantly between the COVID-19 (53.1%) and non-COVID-19 groups (71.1%, p = 0.12). Mechanical power (21.6 vs. 16.8 J/min, p = 0.01) and Charlson Comorbidity Index (6 vs. 5.5, p = 0.02) were significantly higher in non-survivors across the full cohort. Among clinical scores, SOFA was significantly higher in the COVID-19 group (p = 0.02), and APACHE II was significantly higher in non-survivors within the COVID-19 subgroup (p = 0.02). In multivariate analysis, mechanical power and Charlson Comorbidity Index were associated with mortality. Conclusions: COVID-19 patients with ARDS exhibited higher early ventilatory pressures than non-COVID-19 patients, yet early respiratory mechanics were not independently associated with mortality. Mechanical power and Charlson Comorbidity Index were significantly associated with in-hospital mortality. These findings underscore the need to consider both ventilatory load and systemic health status in early outcome assessments of ARDS patients. Full article

Ventilation plays a key role in maintaining indoor air quality and reducing building-related symptoms (BRSs). Although prior studies suggest that ventilation volume and system type may influence BRSs, few have examined their combined effects in residential settings. This cross-sectional study investigated associations between ventilation volume, system type, and BRSs among 3970 residents of newly built detached houses in Japan. Data were collected in two waves in 2023, and the ventilation volume per floor area and per person was calculated from building specifications. BRSs were assessed using the MM040EA Sick House Syndrome questionnaire and analyzed using binary logistic regression stratified by system type. In air supply and exhaust systems, higher ventilation volume per person was linked to a lower prevalence of general symptoms (OR = 0.46). In exhaust-only systems, greater ventilation volume was positively associated with mucosal irritation symptoms (OR = 1.60). These findings highlight the complex relationship between ventilation and health and emphasize the importance of system type. Although air quality parameters were not measured directly, the results provide evidence based on building specifications, thereby offering insight to refine building codes, guide post-occupancy assessments, and inform preventive public health policy. Full article

Most educational buildings in the north of Italy, whether of dated or recent construction, were designed to comply with the thermal comfort and energy performance requirements set for the heating season due to limited use in the summer months. In the latest years, however, with greater frequency, school buildings have been used to host indoor summer activities, and, due to the warm temperature conditions and heat waves, indoor thermal discomfort is often experienced, with negative impacts on occupants’ task performance. Consequently, the need to guarantee adequate indoor thermal comfort in schools in the warm season is becoming a growing concern for local public authorities. In this context, this work examines a set of strategies for the enhancement of the energy performance and indoor thermal comfort of public school buildings in the cooling season. Thus, two case study public school buildings of dated and recent construction located in Bolzano, Italy, were analyzed and compared. This study shows the potential of passive and semi-passive measures in improving indoor thermal comfort in the spring–summer months and the limit beyond which mechanical cooling and ventilation systems are required to ensure adequate levels of indoor environmental quality and task performance in the warmest months. Full article

Obesity Hypoventilation Syndrome (OHS), also known as Pickwickian syndrome, is a complex disorder characterized by obesity (BMI > 30 kg/m²), daytime hypercapnia (PaCO₂ ≥ 45 mmHg), and sleep-disordered breathing, primarily affecting individuals with severe obesity. Its diagnosis requires the exclusion of other causes of alveolar hypoventilation and involves comprehensive assessments, including clinical history, physical examination, pulmonary function tests, arterial blood gases, and sleep studies. The pathophysiology of OHS involves mechanical constraints from excessive adipose tissue, diminished central respiratory drive often linked to leptin resistance, mitochondrial dysfunction, and oxidative stress, all contributing to impaired ventilation and systemic inflammation. The condition often coexists with obstructive sleep apnea (OSA), exacerbating nocturnal hypoxia and hypercapnia, which can lead to severe cardiopulmonary complications such as pulmonary hypertension and right-sided heart failure. Epidemiologically, the rising global prevalence of obesity correlates with an increased incidence of OHS, yet underdiagnosis remains a significant challenge, often resulting in critical presentations like acute hypercapnic respiratory failure. Management primarily centers on non-invasive ventilation modalities like CPAP and BiPAP, with an emphasis on individualized treatment plans, continuous monitoring, and addressing comorbidities such as hypertension and diabetes. Pharmacological interventions are still evolving, focusing on supportive care and metabolic regulation. Long-term adherence, psychological factors, and complications like ventilator failure or device intolerance highlight the need for ongoing multidisciplinary management. Overall, advancing our understanding of OHS’s multifactorial mechanisms and optimizing tailored therapeutic strategies are crucial for improving patient outcomes and reducing mortality associated with this increasingly prevalent syndrome. Full article

Occupancy detection is vital for improving energy efficiency, automation, and security in smart buildings. Reliable detection systems enable dynamic control of lighting, heating, ventilation, air conditioning, and security operations, leading to substantial cost savings and enhanced occupant comfort. However, accurately detecting occupancy using environmental sensor data remains challenging. Existing machine learning and deep learning models, such as Random Forests, convolutional neural networks, and recurrent neural networks, often struggle to capture both fine-grained local patterns and long-range temporal dependencies, limiting their generalization to complex, real-world occupancy patterns. To address these challenges, we propose Translution, a novel hybrid Transformer-based architecture specifically designed for occupancy detection from multivariate sensor time-series data. Translution combines multi-scale convolutional encoding to extract local temporal features, self-attention mechanisms to model long-range dependencies, and an adaptive gating mechanism that dynamically selects relevant features to improve robustness and generalization. We trained Translution on 8143 samples and evaluated it on two distinct subsets of the University of California, Irvine (UCI) Occupancy Detection Dataset: one with shorter, more consistent time spans (2804 samples) and another covering longer, more varied occupancy cycles with abrupt changes and different lighting/ventilation conditions (9752 samples). Evaluating these diverse subsets, which represent both typical and challenging real-world scenarios, explicitly strengthens Translution’s generalizability claim, demonstrating its ability to detect occupancy across varied temporal patterns and environmental conditions accurately. Our results demonstrate that Translution achieves 98.5% accuracy, 97.3% F1-score, and 98.55% area under the receiver operating characteristic curve, significantly outperforming traditional machine learning and deep learning baselines. These findings highlight Translution’s potential as a highly accurate and stable solution for real-time occupancy detection in diverse smart building environments. Full article

The COVID-19 pandemic highlighted the need for a scientific framework that enables quantitative assessment and control of airborne infection risks in indoor environments. This study identifies limitations in the traditional Wells–Riley model—specifically its assumptions of perfect mixing and steady-state conditions—and addresses these shortcomings by adopting the REHVA (Federation of European Heating, Ventilation and Air Conditioning Associations) infection risk assessment model. We propose a five-tier risk classification system (Monitor, Caution, Alert, High Risk, Critical) based on two key metrics: the probability of infection (Pₙ) and the event reproduction number (R_event). Unlike the classical model, our approach integrates airborne virus removal mechanisms—such as natural decay, gravitational settling, and filtration—with occupant dynamics to reflect realistic contagion scenarios. Simulations were conducted across 10 representative indoor settings—such as classrooms, hospital waiting rooms, public transit, and restaurants—considering ventilation rates and activity-specific viral emission patterns. The results quantify how environmental variables (ventilation, occupancy, time) impact each setting’s infection risk level. Our findings indicate that static mitigation measures such as mask-wearing or physical distancing are insufficient without dynamic, model-based risk evaluation. We emphasize the importance of incorporating real-time crowd density, occupancy duration, and movement trajectories into risk scoring. To support this, we propose integrating computer vision (CCTV-based crowd detection) and entry/exit counting sensors within a live airborne risk assessment framework. This integrated system would enable proactive, science-driven epidemic control strategies, supporting real-time adaptive interventions in indoor spaces. The proposed platform could serve as a practical tool for early warning and management during future airborne disease outbreaks. Full article

Hybrid ventilation is indicated as one of the effective methods of maintaining thermal comfort and indoor air quality and reducing energy consumption in buildings. It assumes the capacity to switch between natural and mechanical ventilation, allowing the most efficient use of the outdoor air potential. This article aims to quantify the impact of changing ventilation system, from natural to hybrid, on indoor air parameters and air change rates in a bedroom of a single-family house. The distinct aspects of this study include longitudinal measurement over three years, natural ventilation substituted by hybrid ventilation halfway into the monitoring period, and unaltered building and user characteristics. The analysis is based on measurements of temperature, relative humidity, CO2 concentration, and window opening for three seven-month measurement periods from September 1 to March 31. The measurements are complemented by in-depth user feedback and an audit of the building structure and installed HVAC systems. A clear correlation was observed between the values of relative humidity and carbon dioxide concentration and the type of ventilation strategy. A significant influence of residents’ behavior on the achieved indoor air parameters was observed. Full article

High outdoor PM_2.5 levels in Chinese cities pose significant challenges to maintaining healthy indoor air quality in residential buildings, where mechanical ventilation systems are increasingly adopted for pollution control. In this paper, to control the indoor PM_2.5 concentration, a mass balance equation for the non-uniform mixing model has been established to calculate the filter efficiency. This study aims to optimize PM_2.5 pollution control in residential buildings through mechanical ventilation systems by evaluating the synergistic effects of filter efficiency and ventilation air flow rates under high outdoor PM_2.5 conditions. Field measurements and numerical calculations were conducted to monitor indoor and outdoor PM_2.5 concentrations. Results showed that, When outdoor PM_2.5 concentrations remain below 100 μg/m³, an air exchange rate of 3 h⁻¹ effectively maintains indoor PM_2.5 levels below 35 μg/m³ for M6-F8 air filters. Experimental data demonstrate that when a fresh air system equipped with H10 filters operates at an outdoor PM_2.5 concentration of 150 μg/m³, the corresponding optimal ventilation rate is 0.45 h⁻¹. Increasing the mechanical ventilation rate to 1 h⁻¹ enables the system to effectively handle higher outdoor concentrations up to 176 μg/m³. Under severe pollution scenarios with outdoor PM_2.5 concentrations reaching 250 μg/m³, the air exchange rate should be further increased to 1.65 h⁻¹ to maintain indoor PM_2.5 concentrations within acceptable limits. This study provides practical insights for improving residential indoor air quality under high outdoor PM_2.5 conditions in Chinese cities. Full article

Background/Objectives: Diffuse alveolar hemorrhage (DAH) is a rare but life-threatening complication that might occur in the course of systemic lupus erythematosus (SLE), presenting with acute respiratory symptoms, a rapid drop in hemoglobin, and diffuse pulmonary infiltrates. Despite various studies, clinical and laboratory risk factors for DAH in SLE remain unclear due to small cohort sizes and inconsistent findings. Methods: We analyzed the medical records of all adult SLE patients treated at the University Hospital in Kraków, Poland, from 2012 to 2022, to look for patients with DAH. Results: In a cohort of 1039 SLE patients, DAH was confirmed in five cases (0.48%), all presenting with respiratory symptoms and significant hemoglobin drops. No patients required intensive care unit admission or mechanical ventilation, and all survived the 5-year follow-up after receiving immunosuppressive therapy including glucocorticosteroids and cyclophosphamide, and also rituximab in one case. Common features included constitutional symptoms, hematologic and renal involvement, and frequent presence of antiphospholipid antibodies, with antiphospholipid syndrome diagnosed in three patients (60%). All patients had positive antinuclear antibodies, with the presence of anti-dsDNA and anti-SSA antibodies, each present in 3 out of 5 cases. Conclusions: In conclusion, early recognition and aggressive treatment of DAH in SLE patients, who often present other medical comorbidities as hematological, renal, and cardiovascular manifestations, is critical for improving long-term outcomes. Full article

This paper evaluates the effectiveness of natural ventilation as a health and safety strategy in municipal buildings, focusing on its capacity to ensure indoor air quality and limit airborne disease transmission. Natural ventilation can be incorporated into building design as the primary mechanism for achieving the required indoor air quality, equipping buildings with operable windows based on their intended occupancy. Using 11 public buildings in Mostoles, Spain, as case studies, the research applies a quantitative methodology based on carbon dioxide concentration to estimate ventilation rates and theoretical occupancy thresholds. The findings reveal that cross ventilation is the only natural method capable of meeting air renewal rates recommended by health authorities, particularly the IDA2 air quality standard and three to five air changes per hour suggested to reduce disease spread. However, 53% of the assessed spaces lacked cross ventilation capacity, underscoring the need to integrate natural and mechanical systems. The study proposes a replicable model to assess and adapt indoor occupancy based on real ventilation capacity, offering a practical tool for decision-making in public health, energy efficiency, and architectural design. Ultimately, the research supports the strategic use of natural ventilation as a low-cost, scalable intervention to enhance environmental quality in public facilities. Full article

Background/Objectives: COVID-19 is a systemic viral infection that may lead to serious complications including acute kidney injury that requires kidney replacement therapy. The primary aim of this study was to evaluate urinary SerpinA3 (uSerpinA3) excretion as a biomarker of kidney recovery at 90 days, and the mortality in patients with critical COVID-19 and AKI requiring kidney replacement therapy (KRT). Methods: The study included patients with critical COVID-19 on invasive mechanical ventilation (IMV) requiring KRT. Blood and urine samples were obtained when KRT was initiated (day zero), and thereafter on days 1, 3, 7, and 14 post-replacement. uSerpinA3, kidney injury molecule-1 (uKIM-1), and neutrophil gelatinase-associated lipocalin (uNGAL) were measured in urine, and interleukin-6 (IL-6), interleukin-10 (IL-10), and tumor necrosis factor alpha (TNF-α) in peripheral blood. In addition, metabolomics in sample days zero and 3, and in the survivors on sample day 90 was performed by employing gas chromatography coupled with mass spectrometry. Results: A total of 60 patients were recruited, of whom 29 (48%) survived hospitalization and recovered kidney function by day 90. In the survivors, 79% presented complete recovery (CRR) and the remaining (21%) recovered partially (PRR). In terms of uSerpinA3, levels on days 7 and 14 predicted CRR, with AUC values of 0.68 (p = 0.041) and 0.71 (p = 0.030), respectively, as well as mortality, with AUC values of 0.75 (p = 0.007) and 0.76 (p = 0.015), respectively. Among the other biomarkers, the excretion of uKIM-1 on day zero of KRT had a superior performance as a CRR predictor [(AUC, 0.71 (p = 0.017)], and as a mortality predictor [AUC, 0.68 (p = 0.028)]. In the metabolomics analysis, we identified four distinct profiles; the metabolite that maintained statistical significance in predicting mortality was p-cresol glucuronide. Conclusions: This study strongly suggests that uSerpinA3 and uKIM-1 can predict CRR and mortality in patients with critical COVID-19 and AKI requiring KRT. Metabolic analysis appears promising for identifying affected pathways and their clinical impact in this population. Full article

The development of severe SARS-CoV-2 pneumonia is characterized by extensive lung inflammation, which, in turn, leads to respiratory distress and a decline in blood oxygen levels. Hospital admission, along with intensive care or ventilator usage, becomes necessary because this condition leads to serious respiratory problems. This review aims to provide a comprehensive overview of the pathophysiological mechanisms, diagnostic methods, and current therapeutic options for pneumonia caused by the SARS-CoV-2 virus. The pathophysiological process of severe pneumonia due to SARS-CoV-2 infection is characterized by direct lung damage from viral replication, an excessive immune system response, inflammation, impaired gas exchange, and multi-organ failure. The coexistence of various medical conditions leads to substantial lung impairment, resulting in hypoxia and respiratory failure, which can ultimately lead to fatal outcomes. The diagnosis of severe SARS-CoV-2 pneumonia is made through a combination of clinical, radiologic, and laboratory findings. A multifaceted approach integrating antiviral therapy, corticosteroids, oxygen supplementation, ventilatory management, and immunomodulation is imperative to control inflammation and enhance clinical outcomes. Early intervention, meticulous monitoring, and personalized care are paramount for enhancing survival and mitigating complications in critically ill patients with COVID-19 pneumonia. Full article

Lung transplantation remains the standard of care for end-stage lung disease, yet a persistent gap exists between donor lung availability and growing clinical demand. Expanding the donor pool and optimising donor lung management are therefore critical priorities. However, no universally accepted management protocols are currently in place. This narrative review examines evidence-based strategies to improve lung utilisation across three donor categories: donors after brain death (DBD), controlled donors after circulatory death (cDCD), and uncontrolled donors after circulatory death (uDCD). A systematic literature search was conducted to identify interventions targeting lung preservation and function, including protective ventilation, recruitment manoeuvres, fluid and hormonal management, and ex vivo lung perfusion (EVLP). Distinct pathophysiological mechanisms—sympathetic storm and systemic inflammation in DBD, ischaemia–reperfusion injury in cDCD, and prolonged warm ischaemia in uDCD—necessitate tailored approaches to lung preservation. In DBD donors, early application of protective ventilation, bronchoscopy, and infection surveillance is essential. cDCD donors benefit from optimised pre- and post-withdrawal management to mitigate lung injury. uDCD donor lungs, uniquely vulnerable to ischaemia, require meticulous post-mortem evaluation and preservation using EVLP. Implementing structured, evidence-based lung management strategies can significantly enhance donor lung utilisation and expand the transplantable organ pool. The integration of such practices into clinical protocols is vital to addressing the global shortage of suitable lungs for transplantation. Full article